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.

Abstract

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. 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. 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). 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.