Abstract A018: A retrospective analysis of concomitant opioid usage with immunotherapy in stage IV renal cancer

Abstract Background Opioid analgesics remain the mainstay of pain treatment for patients with advanced cancer. Although adequate relief is a priority, recent studies have shown that opioids may be immunosuppressive, diminishing the efficacy of immunotherapy (IO) treatment. The prognostic impact of the concomitant use of opioids in advanced renal cancer patients receiving IO remains unclear. In this study, we aimed to analyze whether the use of opioids along with IO in patients with stage IV renal cancer impacts clinical outcomes. Methods This study is a retrospective analysis of a cohort of stage IV renal cancer patients treated with IO from 2022 through 2025, at a single NCI-designated comprehensive cancer center. Patients were divided into two groups: patients who used opioids while on IO and those that did not (Opioids and Control groups, respectively). Data collected included demographics (age, gender, race/ethnicity), disease characteristics (histology, sites of metastases, predictive score determined by performance status and lab values), IO characteristics (type of IO, length of therapy, inclusion of other biologic treatments), and opioid characteristics (type of opioid, dose in morphine milligram equivalents MME, length of therapy). The primary outcome measure was overall survival (OS) from time of start of IO therapy to death or date of last follow up. Statistical analysis was descriptive and OS was analyzed using GraphPad Prism v 10 and used the Log Rank test. Results Among 34 Stage IV renal cancer patients, 18 were treated with IO without opioid use (Control) and 16 were treated with opioids and IO concurrently (Opioids). Median age at diagnosis of metastatic disease was 63. 9 (Opioids 60. 3; Controls 64. 4). The predominant race/ethnicity in each group was Hispanic/Latino (37. 5%, N=6) and Non-Hispanic White (61. 1%, N=11) for the Opioids and Control groups, respectively. Predictive scores at diagnosis of metastatic diseases were: Opioids, 12. 5% (N=2) favorable risk, 56. 3% (N=9) intermediate risk, 31. 3% (N=5) high risk; Control, 16. 7% (N=3) favorable risk, 38. 9% (N=7) intermediate risk, 44. 5% (N=8) high risk. Bone metastases were present in 44% of patients (Opioids 75%, N=12; Controls 16. 7%, N=3). Opioids were characterized individually (N=26) as 5 patients had more than 1 opioid with a median MME/day of 30 and median time of treatment of 143. 5 days. The median OS was 71. 4 weeks among patients who received opioids vs. 77. 1 weeks among Controls and was not statistically significantly different (p=0. 60). Conclusions This study showed no change in survival between advanced renal cancer patients taking opioids with IO and those on IO alone. Baseline analysis showed differences in race/ethnicity, predictive scores, and presence of bone metastases between the Opioids and Control groups. Future analysis will be performed to stratify survival and IO treatment response in stage IV renal cancer patients using these variables. Further investigation is needed to understand the potential effects conferred by opioid use in renal cancer patients on IO. Citation Format: Christina A. Boatwright, Mona Yuan, Alexander Sisto, Fuwing Lee, Sanjay Goel. A retrospective analysis of concomitant opioid usage with immunotherapy in stage IV renal cancer abstract. In: Proceedings of the AACR Special Conference in Cancer Research: Innovations in Kidney Cancer Research: From Molecular Insights to Therapeutic Breakthroughs; 2026 Mar 13-16; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2026;86 (5Suppl₂): Abstract nr A018.