PD-1/PD-L1 checkpoint inhibitors during late stages of life: an ad-hoc analysis from a large multicenter cohort

Daniele Santini, Tea Zeppola, Marco Russano, Fabrizio Citarella, Cecilia Anesi, Sebastiano Buti, Marco Tucci, Alessandro Russo, Maria Chiara Sergi, Vincenzo Adamo, Luigia S. Stucci, Melissa Bersanelli, Giulia Mazzaschi, Francesco Spagnolo, Francesca Rastelli, Francesca Chiara Giorgi, Raffaele Giusti, Marco Filetti, Paolo Marchetti, Andrea BotticelliAlain Gelibter, Marco Siringo, Marco Ferrari, Riccardo Marconcini, Maria Giuseppa Vitale, Linda Nicolardi, Rita Chiari, Michele Ghidini, Olga Nigro, Francesco Grossi, Michele De Tursi, Pietro Di Marino, Laura Pala, Paola Queirolo, Sergio Bracarda, Serena Macrini, Stefania Gori, Alessandro Inno, Federica Zoratto, Enrica T. Tanda, Domenico Mallardo, Maria Grazia Vitale, Thomas Talbot, Paolo A. Ascierto, David J. Pinato, Corrado Ficorella, Giampiero Porzio, Alessio Cortellini

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The favourable safety profile and the increasing confidence with immune checkpoint inhibitors (ICIs) might have boosted their prescription in frail patients with short life expectancies, who usually are not treated with standard chemotherapy. Methods: The present analysis aims to describe clinicians’ attitudes towards ICIs administration during late stages of life within a multicenter cohort of advanced cancer patients treated with single agent PD-1/PD-L1 checkpoint inhibitors in Italy. Results: Overall, 1149 patients with advanced cancer who received single agent PD-1/PD-L1 checkpoint inhibitors were screened. The final study population consisted of 567 deceased patients. 166 patients (29.3%) had received ICIs within 30 days of death; among them there was a significantly higher proportion of patients with ECOG-PS ≥ 2 (28.3% vs 11.5%, p < 0.0001) and with a higher burden of disease (69.3% vs 59.4%, p = 0.0266). In total, 35 patients (6.2%) started ICIs within 30 days of death; among them there was a higher proportion of patients with ECOG-PS ≥ 2 (45.7% vs 14.5%, p < 0.0001) and with a higher burden of disease (82.9% vs 60.9%, p = 0.0266). Primary tumors were significantly different across subgroups (p = 0.0172), with a higher prevalence of NSCLC patients (80% vs 60.9%) among those who started ICIs within 30 days of death. Lastly, 123 patients (21.7%) started ICIs within 3 months of death. Similarly, within this subgroup there was a higher proportion of patients with ECOG-PS ≥ 2 (29.3% vs 12.8%, p < 0.0001), with a higher burden of disease (74.0% vs 59.0%, p = 0.0025) and with NSCLC (74.0% vs 58.8%, p = 0.0236). Conclusion: Our results confirmed a trend toward an increasing ICIs prescription in frail patients, during the late stages of life. Caution should be exercised when evaluating an ICI treatment for patients with a poor PS and a high burden of disease.

Original languageEnglish
Article number270
JournalJournal of Translational Medicine
Volume19
Issue number1
DOIs
Publication statusPublished - Dec 2021

Keywords

  • Appropriateness
  • End-of-life
  • Immune checkpoint inhibitors
  • Immunotherapy
  • Palliative care

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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