Patients with advanced cancer selected for immunotherapy had comparable 30-day mortality rates to patients who underwent chemotherapy, according to recent research from the ASCO 2019 Annual Meeting.
Hiren A. Mandaliya, MBBS, MD, FRACP, from Calvary Mater Newcastle Hospital in Waratah, Australia, and colleagues argued that 30-day mortality should be used as a benchmark for quality of life in immunotherapy similar to how it is measured for patients receiving chemotherapy.
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“Mortality within 30 days of chemotherapy in cancer patients has been accepted as a clinical indicator of preventable harm and used as an auditing tool for clinical practice and improving quality of life,” Hiren A. Mandaliya, MBBS, MD, FRACP, from Calvary Mater Newcastle Hospital in Waratah, Australia, and colleagues wrote. “This should be investigated in the current era of immunotherapy, as it has been the standard treatment for advanced melanoma, lung cancer, renal cell cancer and others.”
The researchers performed a retrospective review of 602 patients with metastatic cancer who received immunotherapy (pembrolizumab, ipilimumab, tislelizumab, nivolumab, atezolizumab or MSB0011359C) across 5,022 treatments at their institution between 2006 and 2018. They followed patients who died at 30 days of treatment or earlier and compared the clinical data to 30-day mortality statistics for chemotherapy patients. The median age of patients was 68 years; 47% of patients received first-line therapy compared with 39% of patients as second-line therapy, and the most common cancer types in the cohort were melanoma (63%) and lung cancer (20%).
Of those who received immunotherapy, 76 patients (12.6%) died at 30 days or earlier, and those patients who did die within the 30-day window had an average of 2 doses (1 dose-16 doses). Prior to their last dose, one-fourth of patients had an Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score of 3 or 4. Death related to disease was the most common cause of mortality at 86% of cases, and 80% of patients died in the hospital, with one death from pneumonitis related to treatment. Dr. Mandaliya and colleagues found no association between factors such as age, gender, cancer type, ECOG-PS, immunotherapy type, body mass index or prior treatment. “Thirty-day mortality rates were comparable to published data on patients treated with chemotherapy,” they said.
“To our knowledge, this is the first ever real-world data on 30-day mortality after immunotherapy in advanced cancer,” Dr. Mandaliya and colleagues wrote, adding that the results show the significance of patient selection for immunotherapy in cancer patients.