Evidence map›Paper›PMID 42646554›Full record

Observational studyMedical sciences (Basel, Switzerland)2026

Impact of Angiotensin-Converting Enzyme Inhibitors (ACEIs) on the Efficacy of Immunotherapy in Metastatic NSCLC.

Samer Abu-Rafe, Noa Shani Shrem, Abed Agbarya, Asmah Miari, Ronen Brenner, Yulia Dudnik, Ashraf Abu Jama, Sondos Shalata, Keren Rouvinov, Nashat Abu Yasin and 6 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Medical sciences (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Samer Abu-RafeInternal Medicine Department, Soroka Medical Center, Beer Sheva 84105, Israel.
Noa Shani ShremFaculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel.
Abed AgbaryaDepartment of Oncology, Bnai Zion Medical Center, Haifa 31048, Israel.ORCID 0000-0002-3330-2959
Asmah MiariFaculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
Ronen BrennerFaculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
Yulia DudnikInternal Medicine Department, Soroka Medical Center, Beer Sheva 84105, Israel.
Ashraf Abu JamaFaculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel.
Sondos ShalataNutrition Unit, Galilee Medical Center, Nahariya 22000, Israel.
Keren RouvinovFaculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel.ORCID 0000-0002-8273-4723
Nashat Abu YasinFaculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel.
Lama TourkeyFaculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel.
Adan KhalailyFaculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel.
Raya BdairFaculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel.
Alexander YakobsonFaculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel.
Natalie Maimon RabinovichFaculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
Walid ShalataFaculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel.ORCID 0000-0002-7570-4550

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundImmune checkpoint inhibitors (ICIs) have significantly improved outcomes in metastatic non-small cell lung cancer (NSCLC), yet only a subset of patients derives durable benefit, suggesting that host and tumor-related factors may modify treatment efficacy. The renin-angiotensin system has been implicated in regulation of the tumor microenvironment, and angiotensin-converting enzyme inhibitors (ACEIs) have therefore been proposed as potential modulators of immunotherapy response. MATERIAL AND

methodsWe conducted a retrospective observational cohort study including patients with advanced metastatic NSCLC treated in the first-line setting with treatment-based immunotherapy, with or without chemotherapy, between January 2017 and September 2025. Chronic ACEI exposure was defined as continuous use for at least two years prior to initiation of immunotherapy. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier estimates and compared using the log-rank test, and multivariable Cox proportional hazards models were adjusted.

resultsAmong 446 eligible patients, 71 (16%) received ACEIs and 375 (84%) did not. The median age of the cohort was 67.5 years, and 70% were male. Adenocarcinoma was the predominant histology (67.7%), and most patients received chemo-immunotherapy (81.6%), while 18.4% received immunotherapy alone. PD-L1 expression ≥ 1% was present in 59.2% of patients. In the overall cohort, median PFS and OS were 12 and 15 months, respectively. Median OS was 17 months in the ACEI group compared with 14 months in the non-ACEI group (log-rank

conclusionsThese findings suggest that chronic ACE inhibitor use may be associated with improved outcomes in metastatic NSCLC patients treated with immune checkpoint inhibitors.

Indexed as

Angiotensin-Converting Enzyme InhibitorsCarcinoma, Non-Small-Cell LungImmunotherapyLung NeoplasmsAgedCohort StudiesFemaleHumansImmune Checkpoint InhibitorsMaleMiddle AgedNeoplasm MetastasisRetrospective StudiesTreatment OutcomeAngiotensin-Converting Enzyme InhibitorsImmune Checkpoint Inhibitorsadenocarcinomaangiotensin-converting enzyme inhibitors (ACEIs)immunotherapynon-small cell lung cancerPD-1PD-L1squamous cell carcinoma

Identifiers

PMID42646554
PMCPMC13515793

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.