Real-world outcomes of immunotherapy in advanced NSCLC patients with comorbidities

Background Comorbidities are common in advanced non-small cell lung cancer (NSCLC) patients, yet their impact on systemic anti-cancer treatment (SACT) and survival in the era of immune checkpoint inhibitors (ICIs) remains unclear due to limited representation in clinical trials. Methods This nationwide registry-based study included 9178 patients with stage IIIB–IV NSCLC diagnosed before and after ICI introduction. Kaplan–Meier and multivariable Cox models were applied to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results Common comorbidities included chronic obstructive pulmonary disease (COPD: 22%), cardiovascular disease (CVD: 21%), type 2 diabetes (T2D: 10%), and rheumatic and musculoskeletal diseases (RMD: 6%). Patients with comorbidities were less likely to receive SACT. Following ICI introduction, SACT use increased across all comorbidity groups and 2-year OS improved up to threefold. CVD patients had better 2-year OS when treated with ICI alone than ICI plus chemotherapy (38 vs 22%). Patients with CVD, T2D and RMD had higher risk of death when treated with ICI plus chemotherapy compared to patients without these comorbidities (HR = 1.36 (1.07–1.73), HR = 1.33 (0.99–1.78) and HR = 1.38 (0.97–1.95), respectively). Conclusions Survival among patients with comorbidities improved following ICI introduction, however the benefit varied by comorbidity and treatment modality, supporting more individualised treatment strategies.