Lack of Association Between Immunotherapy and Improvement of Survival for Non-small Cell Lung Cancer Patients With Hemodialysis: A Nationwide Retrospective Cohort Study

• Published in: Clinical lung cancer 2024-03, Vol.25 (2), p.144-150.e3
• Main Authors: Sawa, Kenji, Ihara, Yasutaka, Imai, Takumi, Sugimoto, Akira, Nagamine, Hiroaki, Ogawa, Koichi, Nakahama, Kenji, Matsumoto, Yoshiya, Tani, Yoko, Kaneda, Hiroyasu, Mitsuoka, Shigeki, Kawaguchi, Tomoya, Shintani, Ayumi
• Format: Article
• Language: English
• Subjects: Carcinoma, Non-Small-Cell Lung - drug therapy; Chemotherapy; Hemodialysis; Humans; Immune Checkpoint Inhibitors - therapeutic use; Immunotherapy; Immunotherapy - methods; Lung Neoplasms - drug therapy; NSCLC; Real world data; Retrospective Studies
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2023.11.003

The number of patients undergoing hemodialysis continues to increase globally, and the incidence of cancer is high among these patients. Immune checkpoint inhibitors are widely used in patients with advanced cancer, especially non-small cell lung cancer (NSCLC); however, their effectiveness in hemodialysis patients is poorly documented. This retrospective cohort study used data from a nationwide database. Patients diagnosed with NSCLC, undergoing hemodialysis, and who started chemotherapy between September 2008 and January 2023 were included. In the intention to treat (ITT) analysis, patients were divided into immune checkpoint inhibitor (ICI) and conventional chemotherapy group, and in the chronological analysis, patients were divided into 2 groups before and after ICI approval. Overall survival (OS) was analyzed using the Kaplan–Meier method with log-rank tests and Cox proportional hazards analyses. A propensity score approach was applied to address confounding factors, and analyses were performed by weighting each patient with the inverse of the estimated propensity score. We identified 322 and 389 patients in the ITT and chronological analyses respectively. In both analyses, there were no notable difference of OS between 2 groups (P values by log-rank test 0.933 and 0.248, respectively). The hazard ratios for OS were 0.980 (95% confidence interval [CI]: 0.678–1.415) in the ITT analysis and 0.805 (95% CI: 0.531–1.219) in the chronological analysis. The ICI treatment and approval were not significantly associated with improvement of survival in patients with NSCLC undergoing hemodialysis. This study used a nationwide database to elucidate the association of immunotherapy and survival in patients with nonsmall cell lung cancer undergoing hemodialysis by comparing immunotherapy with conventional chemotherapy. Immunotherapy as the first-line setting was not significantly associated with improvement of survival of these patients. Immunotherapy may not necessarily be the most appropriate first-line therapy for these patients.