Immune checkpoint inhibitors may be ineffective among patients hospitalized with cancer, according to a recent study published by Riaz et al in JCO Oncology Practice.
Background
Immune checkpoint inhibitors have transformed treatment for many cancer types but are often restricted for inpatient use as a result of high costs and lack of reimbursement.
Previous, single-center studies have suggested limited efficacy in hospitalized patients. Many hospitalized patients with cancer have life expectancies shorter than the 2 to 6 months it takes for immune checkpoint inhibitors to be effective.
“[Immune checkpoint inhibitors] are frequently administered to inpatients as a last-ditch effort, despite the lack of robust data supporting their benefit in this setting,” stressed senior study author Deborah Doroshow, MD, PhD, Associate Professor of Medicine (Hematology and Medical Oncology) at The Tisch Cancer Institute at Mount Sinai.
Study Methods and Results
In the large-scale, multicenter retrospective study, investigators analyzed the data of 215 patients who received immune checkpoint inhibitors while hospitalized.
The investigators found that patients who received immune checkpoint inhibitors in the hospital had a median survival of 1.5 months after such treatment. Furthermore, 25% of the patients died in the hospital, and just 12% of them appeared to benefit from treatment. No significant clinical or demographic factors were associated with a positive response to the therapy.
Conclusions
The findings could influence hospital policies regarding the administration of immune checkpoint inhibitors to inpatients. Although many health systems already prohibit their the use of these immunotherapies because of financial constraints, the research reinforced the need for physicians and health systems to reconsider the use of immune checkpoint inhibitors in hospitalized patients based on poor clinical outcomes and suggested that administration of the therapy in this setting should be approached with extreme caution.
“Our study provides clear evidence that most patients do not significantly benefit [from inpatient immune checkpoint inhibitors], and the risks may outweigh the potential rewards,” Dr. Doroshow emphasized. “For [physicians], this serves as a reminder that even though we often hope our patient will be the exception, the reality is that very few patients benefit from inpatient [immune checkpoint inhibitor] therapy. Families and patients should be aware that, despite the promise of immunotherapy in other settings, the likelihood of meaningful benefit in a hospital setting is very low,” she concluded.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
