Early death may be common among cancer patients taking immune checkpoint inhibitors (ICIs), according to a study published in the Journal of the National Cancer Institute.
In a real-world study of more than 7000 cancer patients, 15% had an early death, which was defined as dying within 60 days of starting ICI therapy. Factors such as cancer type, disease stage, and the use of other cancer treatments were associated with the risk of early death.
The study included 7126 patients treated with ICIs from 2012 to 2020. Patients had lung cancer (58.1%), melanoma (23.9%), kidney cancer (10.6%), bladder cancer (4.1%), and head and neck cancer (3.3%).
A total of 1075 patients (15%) died within 60 days of starting ICI therapy. The ICIs patients received included pembrolizumab (40.3%), nivolumab (37.1%), ipilimumab (6.1%), durvalumab (5.9%), atezolizumab (2.2%), avelumab (0.2%), and a combination of ICIs (8.2%).
A multivariable analysis revealed several factors associated with early death. Death within 60 days was more likely among patients who had prior visits to an emergency department (odds ratio [OR], 1.53; 95% CI, 1.31-1.79) or were admitted to the hospital (OR, 1.95; 95% CI, 1.63-2.33).
Early death was also more likely among patients who had received chemotherapy within a year of ICI initiation (OR, 1.36; 95% CI, 1.12-1.64) or radiation 60 days prior to starting ICI therapy (OR, 1.36; 95% CI, 1.16-1.59).
Early death was more likely among patients who had stage IV cancer at diagnosis (OR, 1.28; 95% CI, 1.10-1.50), lower hemoglobin (OR, 1.62; 95% CI, 1.34-1.97), and higher white blood counts (OR, 2.38; 95% CI, 1.98-2.86).
Early death was less likely in patients with lung cancer (OR, 0.63; 95% CI, 0.49-0.82) or kidney cancer (OR, 0.47; 95% CI, 0.33-0.66), compared with patients who had melanoma.
Other factors associated with a lower likelihood of early death were a lower neutrophil-to-lymphocyte ratio (OR, 0.36; 95% CI, 0.29-0.44), a higher body mass index (OR, 0.75; 95% CI, 0.63-0.90), and receiving dual ICI therapy (OR, 0.68; 95% CI, 0.47-0.99).
An analysis of death at 30 days and 90 days showed similar associations. The death rate was 7% at 30 days and 22% at 90 days.
“Mortality early post initiation of ICI is common in patients with cancer treated with ICI,” the researchers concluded. “Several patient, tumor, and system level factors are associated with EM [early mortality] and need to be prospectively validated to ultimately develop a predictive tool to use in routine practice for better patient selection and treatment guidance.”
Raphael J, Richard L, Lam M, et al. Early mortality in patients with cancer treated with immune checkpoint inhibitors in routine practice. J Natl Cancer Inst. Published online May 17, 2023. doi:10.1093/jnci/djad090