Objective: Immune checkpoint inhibitors (ICIs) are novel anticancer agents, also generate peculiar dysimmune toxicities, related to immune-related adverse events (irAEs) that might potentially prolong the survival rate. Our aim was to evaluate diabetes prior to ICIs has any effect on mortality rate, associated with irAEs, to the response in patients inappropriate to operation lung cancer.

Methods: Subjects diagnosed during Sep 1, 2015 to Jul 31, 2018 were retrospectively enrolled and followed until Jan 20, 2018, using Toho University NEPTUNE database. Hazard ratios were estimated using Cox regression weighted for propensity scores. Odds ratios (ORs [95% CI]) were calculated with logistic regression and adjusted for imbalanced variables (standardized difference more than 0.2). The Kaplan-Meier method was used to overall survival, and the generalized Wilcoxon test was used to compare median survivals.

Results: A total of 88 patients participated, of whom 22 (25.0%) had pre-ICIs diabetes (DM) and 57 (75.0%) were not pre-ICIs diabetes (nonDM). The irAEs was observed in 12.2% of DM and 9.1% of nonDM (p=0.33). Both nonDM and DM has not been associated to irAE’s status for baseline characteristics (age, sex, clinical stage, thyroid status, and renal function) and propensity score matching. Multiple logistic regression analyses revealed that the risk of overall survival was significantly lower in subjects with male than those with female (OR = 0.11, 95% CI = 0.01-0.94, p = 0.044). During a mean follow-up of 21.1 months (adherence rate, 88%), overall 37-month post-ICIs survival was significantly lower in the DM group (Kaplan-Meier estimates 77% vs. 66%; p=0 043), resulting in a 38% reduction in the mortality hazard ratio (0 62 [95% CI 0 40-0 95]).

Conclusion: Pre-ICIs treatment diabetes per se, diminish mortality rate in inappropriate to operation lung cancer patients, independently to irAEs on immune-check point inhibitor.


K. Hisanaga: None. H. Uchino: None. F. Yoshikawa: None. F. Shigiyama: None. N. Kumashiro: Speaker's Bureau; Self; Novo Nordisk Inc., Sanofi, Takeda Pharmaceutical Company Limited. T. Hirose: None. Y. Ando: None. M. Miyagi: None. K. Isobe: None. S. Homma: None.

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