Concurrent Statin Use and Overall Survival in Immune Checkpoint Inhibitor‐Treated Mucosal Head and Neck Squamous Cell Carcinoma: A Multi‐Institutional Real‐World Analysis

BACKGROUND: Preclinical evidence suggests statins enhance antitumor immunity. This study evaluates whether concurrent statin use during immune checkpoint inhibitor (ICI) therapy is associated with overall survival (OS) in mucosal head and neck squamous cell carcinoma (HNSCC). METHODS: This retrospective study uses Epic COSMOS, a multi-health system electronic health record dataset. Adults with mucosal HNSCC receiving PD-1 inhibitors were included. Concurrent statin use required ≥ 2 statin orders from -365 to +180 days relative to ICI initiation. The primary outcome was OS from ICI initiation to death or last encounter. RESULTS: Among 21 456 patients, 5719 (26.7%) met concurrent statin criteria. In the fully adjusted model, statin use was associated with increased mortality (HR 1.08; 95% CI 1.04-1.13). In drug-specific analysis, rosuvastatin was associated with reduced mortality (HR 0.87; 0.80-0.96). CONCLUSIONS: Class-level statin use was not associated with improved survival, likely reflecting confounding by cardiovascular comorbidity. Rosuvastatin-specific findings warrant prospective investigation.