Immune Checkpoint Inhibitor Therapy Linked With Improved Quality of Life

Immune checkpoint inhibitor (ICI) therapy appears to maintain or improve quality of life compared with solid cancer treatments that do not include ICIs, a new systematic review and meta-analysis concludes.

Investigators performed a meta-analysis of 34 randomized controlled trials involving 18,709 patients with a range of advanced solid tumors. For immunotherapy, patients received programmed cell death receptor 1, programmed cell death ligand 1 (PD-L1), and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitors as monotherapy or in combination with chemotherapy, another ICI and/or targeted therapy. Control groups received no immunotherapy.

Patient-reported outcomes (PROs) were assessed through the Global Health Status scale from the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire or the EuroQol Health-Related Quality of Life 5-Dimension, 3-Level visual analog scale.

ICI monotherapy was significantly associated with a favorable mean change of 4.6 and 6.1 points in PRO score from baseline to 12 and 24 weeks, respectively, compared with the control group, Laura Pala, MD, of the European Institute of Oncology, Milan, Italy, and colleagues reported in JAMA Network Open.

Quality of life did not worsen when ICI was used together with other therapies. ICIs combined with chemotherapy was associated with a favorable mean change in PRO score of 1.4 and 2.5 points from baseline to 12 and 24 weeks, respectively, compared with the control group. ICI combinations with or without targeted therapies were associated with a favorable mean change in PRO score of 2.1 and 2.1 points from baseline to 12 and 24 weeks, respectively, compared with the control group.

The time to the first clinically meaningful deterioration in PRO score was a significant 20%, 11%, and 22% longer in the groups receiving ICI monotherapy, ICIs plus chemotherapy, and other ICI-containing combinations, respectively, compared with the control group, the investigators reported.

“The benefit was particularly evident when ICIs were administered as monotherapy,” Dr Pala’s team wrote. “In addition, this meta-analysis found that ICIs can be combined with several other classes of anticancer drugs, particularly chemotherapy, without worsening patient quality of life, which is a noteworthy finding considering that such combinations will be increasingly used in many solid tumors.”

The investigators noted that quality of life was a secondary endpoint in most included immune checkpoint inhibitor trials in their analysis. They recommended that future trials incorporate PROs as a primary end point. The investigators could not examine toxicities of specific ICIs in relation to PROs, which is a study limitation.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Pala L, Sala I, Oriecuia C, et al. Association of anticancer immune checkpoint inhibitors with patient-reported outcomes assessed in randomized clinical trials: a systematic review and meta-analysis. JAMA Netw Open. 2022 Aug 1;5(8). Published online August 17, 2022. doi:10.1001/jamanetworkopen.2022.26252

This article originally appeared on Renal and Urology News