Prospective study of association between pretreatment emotional distress and efficacy of immune checkpoint inhibitor in non-small cell lung cancer

Emotional distress (ED), commonly characterized by symptoms of depression and/or anxiety, is prevalent in patients with cancer. Cohort 1 of the prospective STRESS-LUNG study in China investigated the association between pretreatment ED and efficacy of first-line immune checkpoint inhibitors (ICIs) in advanced non-small cell lung cancer (aNSCLC). Patients with pretreatment ED had significantly shorter progression-free survival (primary endpoint) than those without ED (median 7.9 months versus 15.5 months; HR 1.73; p=0.002). ED was also associated with lower objective response rate (46.8% versus 62.1%; OR 0.54; p=0.022), reduced 2-year overall survival rate (46.5% versus 64.9%; HR 1.82; p=0.016), and worse quality of life. Exploratory analysis showed that the ED group had elevated blood cortisol levels, which was associated with adverse survival outcomes. The authors conclude that the study suggests that pretreament ED is associated with worse outcomes of aNSCLC patients receiving first-line ICIs.