ArticleMed (New York, N.Y.)2026
Impact of baseline medications on real-world overall survival in immune checkpoint inhibitor-treated patients with cancer in the RADIOHEAD cohort.
Article in Med (New York, N.Y.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe benefits of immune checkpoint inhibitors (ICIs) observed in clinical trials often fail to translate to patients with cancer treated in a real-world setting. The identification of modifiable or monitorable exposures, such as baseline medication status, that may influence patient outcomes is necessary to reconcile disparities between clinical trial and real-world ICI efficacy.
methodsWe analyzed baseline medication use obtained through electronic data capture (EDC) from the real-world RADIOHEAD cohort, a prospective, pan-cancer collection of immunotherapy-naive patients receiving standard-of-care ICI treatment across the United States. Survival analyses were performed to evaluate associations between both individual and cumulative medication exposures and real-world overall survival (rwOS).
findingsOf 1,024 patients from the RADIOHEAD cohort, 55% (n = 564/1,024) were exposed to polypharmacy, defined as more than five drug classes, at ICI initiation. Polypharmacy, explored as a continuous variable of cumulative medication exposure, was significantly associated with worse rwOS (hazard ratio [HR] 1.06 [95% confidence interval [CI] 1.03-1.10], p < 0.001, q = 0.005). Among individual medication class exposures, there was a strong association between opioids and worse rwOS (HR 1.79 [95% CI 1.43-2.24], p < 0.001), as well as beta-blocker use (HR 1.38 [95% CI, 1.10-1.72], p = 0.005), after adjusting for clinically relevant covariates and patterns of co-prescription. The association between opioid exposure and worse rwOS was independent of additional palliative medication use (HR 1.61 [95% CI 1.09-2.36], p = 0.016, p for interaction = 0.4) and persisted in patients with early-stage and non-metastatic disease (p = 0.044).
conclusionsPolypharmacy and baseline medication exposures, particularly opioid and beta-blocker use, have prognostic significance for rwOS in patients with cancer receiving ICI treatment. This study evaluates the influence of baseline medications on ICI efficacy within the context of cumulative medication exposures reflective of co-prescription.
fundingThis study was supported in part by the National Institutes of Health and the Parker Institute for Cancer Immunotherapy (PICI).
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