Increased opioid consumption in neoadjuvant immunotherapy plus chemotherapy for patients with non‐small‐cell lung cancer: A multicenter, prospective cohort study

• Published in: CNS neuroscience & therapeutics Vol. 30; no. 8; pp. e14893 - n/a
• Main Authors: Wang, Kaiyuan, Er, Jianxu, Zhang, Yu, Song, Chengcheng, Yu, Yang, Gao, Ruifang, Xu, Hong, Dong, Xiaolin, Yuan, Limei, Liu, Qiangwei, Han, Jiange, Yu, Yonghao, Yin, Yiqing
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.08.2024; John Wiley and Sons Inc
• Subjects: Adult; Aged; analgesia; Analgesics; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Anesthesia; Body mass index; Cancer therapies; Carcinoma, Non-Small-Cell Lung - surgery; Chemotherapy; Cognitive ability; Cohort analysis; Cohort Studies; Delirium; Female; Humans; Immunotherapy; Immunotherapy - methods; Lung cancer; Lung Neoplasms; Male; Medical prognosis; Middle Aged; Morphine; Narcotics; neoadjuvant immunotherapy; Neoadjuvant Therapy; Non-small cell lung carcinoma; non‐small‐cell lung cancer; opioid consumption; Opioids; Original; Pain; Pain perception; Pain, Postoperative; Patients; PD-L1 protein; postoperative delirium; postoperative pain; Prospective Studies; Regression analysis; Statistical analysis; Sufentanil; Surgery; non‐small‐cell lung cancer; opioid consumption; postoperative delirium; neoadjuvant immunotherapy; postoperative pain; analgesia
• ISSN: 1755-5930; 1755-5949; 1755-5949
• DOI: 10.1111/cns.14893

Aims PD‐1 block was reported to impair opioid‐induced antinociception and affect cognitive function in rodents and non‐human primates. This prospective multicenter cohort study aims to investigate the possible impact of neoadjuvant immunotherapy with PD‐1 antibody on perioperative analgesic effect of opioids and postoperative delirium (POD) for non‐small‐cell lung cancer (NSCLC) patients. Methods Eighty‐four NSCLC patients from three medical centers with neoadjuvant chemoimmunotherapy (nCIT) or chemotherapy (nCT) were enrolled. The primary outcome is the total perioperative opioid consumption defined as the sum of intraoperative and postoperative opioid use within 3 days after surgery. Secondary outcomes compromise of incidence of POD, pain intensity, and number of analgesic pump press. Tumor prognostic parameters and perioperative change of inflammatory cytokines and soluble PD‐L1 level were also recorded. Results Eighty‐one patients were included in the final analysis. The total opioid consumption (sufentanil equivalent) perioperatively in the nCIT group was significantly higher than that in the nCT group, with mean difference of 60.39 μg, 95% CI (25.58–95.19), p < 0.001. Multiple linear regression analysis showed that nCIT was correlated with increased total opioid consumption (β = 0.305; 95% CI, 0.152–0.459; p < 0.001). The incidence of moderate‐to‐severe pain and cumulative analgesic pump press within 72 h was significantly higher in subjects with nCIT. There is no statistical difference in incidence of POD between groups within 72 h after surgery. The pathologic complete response rate and perioperative serum IL‐6 level were higher in the nCIT group than in the nCT group. Conclusion Patients with NSCLC receiving nCIT warrant increased opioid consumption perioperatively and suffered from more postoperative pain. Clinical Trial Registration NCT05273827. Patients with non‐small‐cell lung cancer receiving neoadjuvant chemoimmunotherapy warrant increased opioid consumption perioperatively and suffered from more postoperative pain compared with patients receiving neoadjuvant chemotherapy alone. However, there is no statistical difference in incidence of postoperative delirium (POD) between groups within 72 h after surgery.