High-intensity statins are associated with improved clinical activity of PD-1 inhibitors in malignant pleural mesothelioma and advanced non-small cell lung cancer patients. (February 2021)

• Record Type: Journal Article
• Authors: Cantini, Luca; Pecci, Federica; Hurkmans, Daan P.; Belderbos, Robert A.; Lanese, Andrea; Copparoni, Cecilia; Aerts, Sophie; Cornelissen, Robin; Dumoulin, Daphne W.; Fiordoliva, Ilaria; Rinaldi, Silvia; Aerts, Joachim G.J.V.; Berardi, Rossana
• Is Part Of: European journal of cancer. Volume 144(2021)
• Page Start: 41
• Page End: 48
• Publication Date: 2021-02
• Subjects: Lung cancer -- Mesothelioma -- Immunotherapy -- Pembrolizumab -- Nivolumab -- Statin; CI confidence interval -- ECOG PS Eastern Cooperative Oncology Group Performance Status -- HR hazard ratio -- MPM malignant pleural mesothelioma -- MVA mevalonate -- NSCLC non-small cell lung cancer -- ORR objective response rate -- OS overall survival -- PD-1 programmed cell death protein 1 -- PFS progression-free survival; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2020.10.031
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: In preclinical models, statins showed vaccine adjuvant activities and synergized with PD-1 inhibitors. We analyzed the impact of statin treatment on clinical outcome in thoracic cancer patients treated with PD-1 inhibitors. Methods: A total of 82 malignant pleural mesothelioma (MPM) and 179 advanced non-small cell lung cancer (aNSCLC) patients treated with PD-1 inhibitors as second or further line treatment were examined. Seventy-seven MPM patients treated with standard chemotherapy were analyzed as control cohort. Objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were calculated. Results: Among 253 patients with available data, statin use was associated with increased ORR (32% versus 18%, P = .02), PFS (median 6.7 versus 2.9 months, hazard ratio [HR] 0.57, 95% CI 0.39–0.83, P < .01), and OS (median 13.1 versus 8.7 months, HR 0.67, 95% CI 0.45–1.00, P = .05). In the control MPM cohort treated with chemotherapy (n = 77), no association was found. MPM patients who used statins showed improved ORR (22% versus 6%, P = .05), PFS (median 6.7 versus 2.4 months, P < .01), and OS (median not reached versus 6.0 months, P = .01). In aNSCLC patients, statin use was associated with improved ORR (40% versus 22%, P = .04) and PFS (median 7.8 versus 3.6 months, P = .03), but no significant difference in OS was found (median 13.1 versus 10.1 months, P = .30). Multivariable analysis confirmed the correlation between statin use and better PFS and OS in MPM and better PFS in aNSCLC. In the whole cohort, high but not low/moderate-intensity statins were associated with better OS compared to no user ( P = .02 and P = .59, respectively). Conclusions: Our study showed that statins are associated with better clinical outcome in MPM and aNSCLC patients treated with PD-1 inhibitors in an intensity-dependent manner. Highlights: In pre-clinical models, statins synergized with PD-1 inhibitors. Statins associated with outcome in MPM and NSCLC patients treated with PD-1 inhibitors. This association was stronger in patients who used high-intensity statins. No association found between statins & outcome in the control MPM chemotherapy cohort.