WCLC 2025 - Posters & ePosters-EP.11.07 Type2 Diabetes Mellitus Affect Prognosis and Immune Checkpoint Inhibitor Treatment Efficacy for Advanced Non Small Cell Lung Cancer

EP.11.07 Type2 Diabetes Mellitus Affect Prognosis and Immune Checkpoint Inhibitor Treatment Efficacy for Advanced Non Small Cell Lung Cancer

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This study by Kato et al. investigates the impact of type 2 diabetes mellitus (T2DM) on the prognosis and treatment efficacy of advanced non-small cell lung cancer (NSCLC), focusing particularly on immune checkpoint inhibitors (ICI), molecular targeted therapy (MTT), and cytotoxic chemotherapy (CTT). Conducted at Nippon Medical School Chiba-Hokuso Hospital, the study included 257 advanced NSCLC patients receiving systemic therapy since 2018, categorized into ICI (n=115), MTT (n=116), and CTT (n=26) cohorts, with subgroups based on diabetes status.<br /><br />Key findings revealed that T2DM is an independent adverse prognostic factor for overall survival (OS) in advanced NSCLC across treatments. Patients with T2DM had significantly shorter OS compared to non-diabetics (e.g., 19.3 vs. 34.5 months overall; HR 1.76, p=0.0014). This negative effect was particularly pronounced in the ICI cohort, where diabetic patients had OS of 11.5 vs. 34.2 months (HR 2.13, p=0.0049) and reduced progression-free survival (PFS). In contrast, no significant impact of diabetes on PFS was seen in MTT or CTT cohorts.<br /><br />The study also found elevated systemic inflammatory markers, such as derived neutrophil-to-lymphocyte ratio (dNLR) and NLR, in diabetic patients, which correlated with glycemic control and may contribute to diminished ICI efficacy. Interestingly, strict glycemic control, including specialist diabetes consultations, appeared to improve PFS among ICI-treated patients. There was no clear association between specific diabetes medications and cancer outcomes.<br /><br />These results align with emerging evidence that T2DM-associated systemic inflammation and immune dysregulation may impair ICI therapeutic effects. Prior reports indicate diabetes elevates serum NLR and modulates tumor immune microenvironment negatively impacting T cell function.<br /><br />In conclusion, T2DM worsens prognosis in advanced NSCLC and reduces ICI efficacy, potentially via inflammation-mediated immune suppression. Optimal diabetes management may improve outcomes with ICI therapies, highlighting the need for integrated oncologic and metabolic care in this population.

Asset Subtitle

Yasuhiro Kato

Meta Tag

Speaker Yasuhiro Kato

Topic Metastatic Non-small Cell Lung Cancer – Immunotherapy

Keywords

type 2 diabetes mellitus

advanced non-small cell lung cancer

immune checkpoint inhibitors

molecular targeted therapy

cytotoxic chemotherapy

overall survival

progression-free survival

systemic inflammation

glycemic control

immune dysregulation