Thyroid dysfunction as a predictor of PD- 1/PD-L1 inhibitor efficacy in advanced lung cancer

Abstract

Purpose: To investigate the correlation between thyroid dysfunction (TD) and the efficacy of programmed cell death protein 1 (PD-1) and programmed death ligand 1 (PD-L1) inhibitors in the treatment of advanced lung cancer, and the possible influencing factors for TD occurrence, providing insights that could guide individualized therapeutic approaches. Methods: The data of 120 advanced lung cancer patients from January 2019 to August 2024 were retrospectively collected. Then, the patients were divided into TD and non-TD subgroups according to whether TD occurred or not, to analyse the possible factors influencing the occurrence of TD and the correlation between TD and PD-1/PD-L1 inhibitor efficacy. Results: For all cases, the baseline TSH level was significantly higher in the TD subgroup than in the non-TD subgroup (median: 2.33 mIU/L vs. 1.58 mIU/L, p = 0.001). The progression-free survival (PFS) was significantly longer in the TD subgroup than in the non-TD subgroup (mPFS: 7.90 months vs. 4.87 months, p = 0.003), and the patients in the TD subgroup had a lower HR for progression (0.499, 95% CI (0.317–0.766)). For the PD-1/PD-L1 inhibitor group, the baseline TSH level was also significantly higher in the TD subgroup than in the non-TD subgroup (median: 2.16 mIU/L vs. 1.52 mIU/L, p = 0.009). The PFS was also significantly longer in the TD subgroup than in the non-TD subgroup (mPFS: 8.83 months vs. 6.50 months, p = 0.041). Conclusions: The baseline TSH level was the predictive factor for the occurrence of TD. The occurrence of TD was positively associated with a favorable prognosis for patients with advanced lung cancer.