End-of-life immunotherapy uptake on the rise

More and more patients in the US are being initiated on immunotherapy within 1 month of death, reflecting the rise in use of immunotherapy overall, according to a study.

For the retrospective cohort study, researchers used data from a US national clinical database of patients with metastatic melanoma, nonsmall cell lung cancer (NSCLC), or kidney cell carcinoma (KCC) diagnosed after US Food and Drug Administration approval of immune checkpoint inhibitors for the treatment of each disease.

The analysis included 242,371 patients (mean age 67.9 years, 56.0 percent men), of which 29.3 percent received immunotherapy. A total of 20,415 patients had stage IV melanoma, 197,331 had stage IV NSCLC, and 24,625 had stage IV KCC. The mean follow-up was 13.7 months.

Over time, the percentage of patients who received EOL-I immunotherapy increased for all cancers: from 0.8 percent to 4.3 percent for melanoma, from 0.9 percent to 3.2 percent for NSCLC, and from 0.5 percent to 2.6 percent for KCC. Notably, more than one in 14 immunotherapy treatments in 2019 were initiated within 1 month of death.

Compared with lymph node involvement only, having three or more organs involved in metastatic disease was associated with a 3.8-fold higher likelihood (95 percent confidence interval [CI], 3.1–4.7; p<0.001) of dying within 1 month of immunotherapy initiation.

On the other hand, treatment at an academic or high-volume centre rather than a nonacademic or very low-volume centre was associated with a 31-percent (odds ratio [OR], 0.69, 95 percent CI, 0.65–0.74; p<0.001) and 30-percent (OR, 0.70, 95 percent CI, 0.65–0.76; p<0.001) lower odds of death within a month of initiating immunotherapy, respectively.

The findings provide insights into national prescribing patterns and may serve as a harbinger for shifts in the clinical approach to patients with advanced cancer, the researchers said.