Impact of renin–angiotensin system inhibitors on the clinical outcomes of nivolumab therapy in metastatic non–small cell lung cancer

Background The objective of this study is to evaluate the correlation between survival outcomes and renin angiotensin system inhibitors (RASI) use in patients treated nivolmab with metastatic non-small cell lung cancer (mNSCLC).Methods This retrospective cohort multicentre study was conducted on patients with mNSCLC patients treated Nivolumab monotherapy as second line therapy. Factors affecting the survival of patients receiving concurrent RASI therapy with nivolumab were analyzed.Results 614 patients were included. A total of 288 patients (46.9%) were using concurrent RASI. Patients using RASIs had a median progression free survival (PFS) of 10 months compared to 7 months in non-users. In the multivariate analysis, RASI use (HR: 0.747, 95% CI: 0.594–0.941; p: 0.013) was associated with improved PFS. RASI use was also significantly associated with overall survival (OS), median OS of 20 months in users and 12 months in non-users. In the multivariate analysis, RASI use (HR: 0.600, 95% CI: 0.458–0.787; p < 0.001) was associated with improved OS.Conclusions In this multicenter real-world study of patients with mNSCLC receiving second-line nivolumab, concomitant use of RASIs was associated with PFS and OS. The integration of RAS blockade into immunotherapy regimens could represent a promising strategy to enhance treatment efficacy.