Common Drugs Don't Affect Survival in Lung Cancer Patients on Immunotherapy

Large cohort study finds no meaningful impact of common medications on outcomes for stage IV NSCLC patients receiving immune checkpoint inhibitors.

Published on Feb. 16, 2026

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A cohort study of over 10,000 veterans with stage IV non-small cell lung cancer (NSCLC) found that commonly prescribed medications like antibiotics, proton pump inhibitors, opioids, and statins did not significantly affect treatment outcomes for patients receiving immune checkpoint inhibitor (ICI) therapy. The study used a chemotherapy negative control group to distinguish true drug-ICI interactions from confounded associations, concluding that prior reports of such associations likely reflected statistical errors or residual confounding rather than real pharmacologic effects.

Why it matters

Immunotherapy has transformed cancer treatment, but concerns have been raised that common medications could interfere with ICI efficacy. This large real-world study provides reassurance that appropriate concomitant medication use can proceed alongside ICIs without fear of undermining treatment, allowing clinicians to focus on clinical needs and supportive care rather than worrying about potential drug interactions.

The details

Researchers analyzed data on 3,739 patients with stage IV NSCLC who received first- or second-line ICI therapy and 6,585 patients who received chemotherapy. Baseline use of 20 medication classes within 3 months before therapy was assessed, along with an "immunomodulatory drug score" based on recent use of antibiotics, proton pump inhibitors, and corticosteroids. After propensity weighting, the study found that use of 15 of 20 medication classes showed no association with overall survival, and 14 of 20 classes showed no association with time to next treatment in the ICI cohort. Some medications like loop diuretics, anticoagulants, and certain antibiotics were associated with worse outcomes in both the ICI and chemotherapy control groups, suggesting the associations reflected prognostic differences rather than true drug-ICI interactions.

  • The study analyzed data from 2015 to 2024 for ICI-treated patients and 2005 to 2015 for chemotherapy-treated patients.

The players

Daria Brinzevich

The lead author of the study, who is affiliated with the University of Michigan in Ann Arbor.

Parham Habibzadeh

A researcher at the University of Pittsburgh who co-authored an editorial accompanying the study.

Diwakar Davar

A researcher at the University of Pittsburgh who co-authored an editorial accompanying the study.

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What they’re saying

“Brinzevich et al. deliver one of the most convincing real‐world evaluations to date of how common medications influence ICI outcomes, demonstrating that when rigorous confounding control is paired with an explicit negative control design, many previously reported drug-ICI associations resolve into patterns consistent with prognosis rather than pharmacologic antagonism or potentiation.”

— Parham Habibzadeh, Researcher, University of Pittsburgh (Cancer)

“Until prospective or mechanism‐anchored studies demonstrate otherwise, clinicians and patients can be reassured that appropriate concomitant medication use should proceed alongside ICIs, guided by clinical need and best practices in supportive care rather than fear of undermining treatment efficacy.”

— Diwakar Davar, Researcher, University of Pittsburgh (Cancer)

What’s next

The study authors noted several limitations, including the observational design, predominance of older male veterans in the cohort, and potential for misclassification bias. Additional prospective or mechanism-focused studies may be needed to fully understand any potential interactions between common medications and immunotherapy.

The takeaway

This large real-world study provides reassurance that commonly used medications like antibiotics, proton pump inhibitors, opioids, and statins do not meaningfully impact outcomes for stage IV NSCLC patients receiving immune checkpoint inhibitor therapy. Clinicians can focus on appropriate supportive care rather than worrying about potential drug interactions undermining immunotherapy effectiveness.