Patients with metastatic non-small cell lung cancer (mNSCLC) and bone metastasis treated with an immune checkpoint inhibitor (ICI) had shorter overall survival than patients without bone metastasis, according to a recent study published in the Journal of the National Comprehensive Cancer Network.    

The study researchers stated that “…when accounting for metastatic burden, the presence of bone metastases was still a negative prognostic factor,” adding that this difference in survival is not seen when patients are treated with chemotherapy. “This analysis supports that bone metastases convey a different prognostic significance depending on treatment modality (chemotherapy vs immunotherapy) and adds to the literature supporting the negative impact of bone metastases in the era of checkpoint inhibition in mNSCLC.”

The retrospective study included data from 330 patients who were treated with ICIs for mNSCLC. Overall survival was compared between patients with bone metastases at baseline (38%) and patients without bone metastases at baseline.

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Most patients received ICIs in the second-line or beyond; the most common ICI administered was nivolumab (64%). Median overall survival was 10 months.

Thirteen percent of patients developed skeletal-related events during or after ICI treatment. Median time to skeletal-related event was 2.8 months.

The median overall survival for patients with bone metastases was 5.9 months compared with 13.4 months for those without (P <.001). After controlling for performance status, histology, line of therapy, and disease burden, bone metastases were associated with an increased risk of death (hazard ratio=1.57; 95% CI, 1.19-2.08; P =.001).

In addition, the researchers found that the use of bone-modifying agents did not reduce skeletal-related events or result in a difference in survival outcomes.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original article for a full list of authors’ disclosures.


Qin A, Zhao S, Miah A, et al. Bone metastases, skeletal-related events, and survival in patients with metastatic non–small cell lung cancer treated with immune checkpoint inhibitors. J Natl Compr Canc Netw. Published online April 20, 2021. doi:10.6004/jnccn.2020.7668