Cancer Patients Self-Report Significant Improvement in Quality of Life With Immune Checkpoint Inhibitors

Researchers found a positive association between treatment with immune checkpoint inhibitors (ICIs) and patient-reported quality of life (QoL) for individuals with advanced tumors. ICIs can be used as a monotherapy or work alongside other classes of anticancer drugs to preserve a healthy QoL.

ICIs are a form of monotherapy cancer treatment, but can be also combined with immunotherapy or other anticancer agents. The QoL of patients with metastatic cancer can depend on socioeconomic factors, treatment effects, or psychological conditions.

Therefore, researchers used patient-reported outcomes (PROs) to individualize patients and capture their authentic QoL. Investigators decided to explore the association between ICIs and patient QoL. They conducted the trial through a systematic review and random-effects meta-analysis of randomized clinical trials (RCTs) from online databases to test immunotherapy-based treatments vs non-immunotherapy anticancer treatments.

Researchers evaluated 2 coprimary endpoints. First, they assessed differences between treatment groups in the mean change of PRO score from baseline to 12 weeks and baseline to 24 weeks. Second, they assessed patient PRO score and differences in time of deterioration. Clinical meaningful change of PRO score were between 5 and 10 points on the EORTC QLQ-C30 GHS scale or a score of 7+ on the EQ-5D-3L VAS scale.

Looking at more than 18,000 patients with solid tumors from 34 RCTs, they split participants into groups who either received ICIs as monotherapy, combined with chemotherapy, or combined with another ICI and/or targeted therapy. All these participants were compared to a control group who did not receive any immunotherapy.

Studying 19 RCTs of patients using monotherapuetic ICIs, investigators calculated the pooled between-groups difference of mean change from baseline to 12 weeks to be 4.6. From baseline to 24 weeks, the value increased to 6.1.

Among 8 RCTs that combined ICIs with chemotherapy, the pooled difference was 1.4 at week 12 and 2.5 at week 24. Finally, among 8 RCTs testing other ICI-containing combinations, the mean change from baseline to week 12 was 2.1 (95% CI, −0.8 to 5.0) and was 2.1 at week 24 (95% CI, −0.4 to 4.5).

In all 3 groups, the immunotherapy-containing groups had a longer time to deterioration than the control group. The results showed that participants especially favored ICI as a standalone monotherapy. However, ICIs, when combined with other chemotherapies and anticancer treatments, did not worsen patient QoL and will be used going forward.

The authors identified some limitations to the study. Due to the short duration of the trial, conclusions about health related QoL could not be fully determined; however, multidrug combinations did not worsen quality of life.

The study was also limited to pre-published data. Additionally, some cancer histotypes only had a few random clinical trials available to analyze. Finally, the authors did not include studies looking at ICIs as neoadjuvant or adjuvant treatment to avoid heterogeneity, limiting conclusions about ICI treatment to patients with advanced progression of their disease.

Reference

JAMA Network. Association of Anticancer Immune Checkpoint Inhibitors With Patient-Reported Outcomes Assessed in Randomized Clinical Trials. JAMA Network website. August 16, 2022. Accessed on August 16, 2022. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795184