Immune checkpoint inhibitor (ICI) therapy appears to maintain or improve quality of life in patients with solid tumor malignancies, when compared with treatments that do not include ICIs, according to a systematic review and meta-analysis published in JAMA Network Open.
Investigators performed a meta-analysis of 34 randomized controlled trials involving 18,709 patients with a range of advanced solid tumors, including lung cancer, melanoma, renal cell carcinoma, urothelial carcinoma, head and neck cancer, hepatocellular carcinoma, gastroesophageal cancer, colon cancer, breast cancer, and mesothelioma.
For immunotherapy, patients received PD-1/PD-L1 and 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.
Quality of life did not worsen when ICIs were used together with other therapies. ICIs combined with chemotherapy were 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 benefit was particularly evident when ICIs were administered as monotherapy,” the investigators 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 ICI trials in this analysis. They recommended that future trials incorporate PROs as a primary endpoint. The investigators could not examine toxicities of specific ICIs in relation to PROs, which is a study limitation.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
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. Published online August 17, 2022. doi:10.1001/jamanetworkopen.2022.26252
This article originally appeared on Renal and Urology News