Immunotherapy Initiation at the End of Life for Patients With Metastatic Cancers

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In an analysis reported in JAMA Oncology, Kerekes et al found that initiation of immunotherapy at the end of life has increased over time in U.S. patients with metastatic cancers.

Study Details

The retrospective cohort study used data from the National Cancer Database on patients with stage IV melanoma (n = 20,515), non–small cell lung cancer (NSCLC; n = 197,331), and renal cell carcinoma (n = 24,625) diagnosed after U.S. Food and Drug Administration approval of immune checkpoint inhibitors for the treatment of each disease through December 2019. Main outcome measures included end-of-life immunotherapy, defined as immunotherapy initiated within 1 month of death.

Key Findings

Mean follow-up was 13.7 months. The percentage of patients receiving end-of-life immunotherapy increased over time since the approval of appropriate immunotherapies, from 0.8% to 4.3% in patients with melanoma, 0.9% to 3.2% in those with NSCLC, and 0.5% to 2.26% in those with renal cell carcinoma. Overall, more than 1 in 14 immunotherapies in 2019 were initiated within 1 month of death.

Risk-adjusted patients with three or more organs involved in metastatic disease were 3.8-fold more likely (95% confidence interval [CI] = 3.1–4.7, P < .001) to receive end-of-life immunotherapy vs those with lymph node involvement alone.

Treatment at an academic vs nonacademic center was associated with a reduced risk of end-of-life immunotherapy (odds ratio [OR] = 0.69, 95% CI = 0.65–0.74, P < .001). Treatment at high-volume vs low-volume sites was also associated with a reduced use of end-of-life immunotherapy (OR = 0.70, 95% CI = 0.65–0.76, P < .001).  

The investigators continued: “Findings of this cohort study show that the initiation of immunotherapy at the end of life is increasing over time. Patients with higher metastatic burden and who were treated at nonacademic or low-volume facilities had higher odds of receiving end-of-life–[initiated] immunotherapy. Tracking end-of-life–[initiated] immunotherapy can offer insights into national prescribing patterns and serve as a harbinger for shifts in the clinical approach to patients with advanced cancer.”

Sajid A. Khan, MD, of the Department of Surgery, Yale School of Medicine, is the corresponding author of the JAMA Oncology article.

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