Re: Comments on 'High-intensity statins are associated with improved clinical activity of programmed cell death protein 1 inhibitors in malignant pleural mesothelioma and advanced non-small cell lung cancer patients'

Our plain-English summary of Re: Comments on 'High-intensity statins are associated with improved clinical activity of programmed cell death protein 1 inhibitors in malignant pleural mesothelioma and advanced non-small cell lung cancer patients', by L. Cantini, F. Pecci, F. Dammeijer, et al (European Journal of Cancer, 2021).

The study

• Authors: L. Cantini, F. Pecci, F. Dammeijer, J.G.J.V. Aerts, R. Berardi
• Journal: European Journal of Cancer
• Published: 2021;153:267-269
• Type of article: Letter, Comment
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This letter to the editor was the authors' reply to comments on their earlier study of statins in patients with malignant pleural mesothelioma (MPM) or advanced non-small cell lung cancer (NSCLC) treated with PD-1 inhibitor immunotherapy. The letter did not examine asbestos exposure or its effects. The authors noted that they had reported MPM and NSCLC patients separately as well as together, and that the association between statin use and outcomes was consistent in both groups. They acknowledged that they could not determine how long patients had taken statins before immunotherapy. They restated that high-intensity statin users had an overall response rate of 46% versus 18% in non-users, and that no association was found in chemotherapy-treated patients. They accepted that adjusting for histological subtype had probably caused over-adjustment. With it removed, statin use kept its association with outcomes: hazard ratios were 0.42 for progression-free survival and 0.35 for overall survival in MPM, and 0.51 for progression-free survival in NSCLC. The authors called their study primarily hypothesis generating and said randomised trials are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor: the authors' reply to published comments on their own earlier study
• Who was studied: Patients with malignant pleural mesothelioma (MPM) and patients with advanced non-small cell lung cancer (NSCLC) treated with PD-1 inhibitors in the authors' earlier study. Numbers, place and dates are not given in this letter.
• Exposure: Statin use, in particular statin intensity (the expected lowering of low-density lipoprotein for the specific statin and dose), in patients receiving PD-1 inhibitors. No asbestos exposure was studied.
• Main results:
  • The association between statin use and clinical outcomes was consistent in the MPM and NSCLC cohorts when they were analysed separately.
  • High-intensity statin users had an overall response rate of 46%, compared with 18% in non-users.
  • No association between statin use and outcomes was found in patients treated with chemotherapy.
  • After histological subtype was removed from the multivariate models, statin use kept its association with outcomes. In MPM the hazard ratio was 0.42 (P = .02) for progression-free survival and 0.35 (P = .01) for overall survival. In NSCLC the hazard ratio was 0.51 (P = .02) for progression-free survival. No confidence intervals were given.
• The authors' conclusion: The authors stated that whether statin use reflects a general prognostic association or is causally linked with better results from PD-1 inhibitors needs further testing in randomised trials.
• Limitations the authors state:
  • It was not possible to determine how long patients had been exposed to statins before immunotherapy.
  • Histological subtype did not meet all the criteria of a confounding factor, so adjusting for it probably led to over-adjustment.
  • The authors acknowledged that the study has limitations and considered it primarily hypothesis generating.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Non-Small Cell Lung Cancer.

Related studies

• High-intensity statins are associated with improved clinical activity of PD-1 inhibitors in malignant pleural mesothelioma and advanced non-small cell lung cancer patients — L. Cantini, F. Pecci, et al. (2021)
• Re: 'High-intensity statins are associated with improved clinical activity of PD-1 inhibitors in malignant pleural mesothelioma and advanced non-small cell lung cancer patients' — A. Hara, M. Matsuda, et al. (2021)
• Statins do not alter the incidence of mesothelioma in asbestos exposed mice or humans — C. Robinson, H. Alfonso, et al. (2014)
• Promoter methylation of DAP-kinase: association with advanced stage in non-small cell lung cancer — D.H. Kim, H.H. Nelson, et al. (2001)
• Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial — C. Baldwin, A. Spiro, et al. (2011)
• A randomised study comparing the effectiveness of acupuncture or morphine versus the combination for the relief of dyspnoea in patients with advanced non-small cell lung cancer and mesothelioma — A. Minchom, R. Punwani, et al. (2016)

Browse more research in European Journal of Cancer, or return to medical research.