by A recent study conducted by researchers at the Yale Cancer Center in Yale School of Medicine has discovered a significant rise in the number of patients initiating immunotherapy within one month of their death. The study, which utilized a national clinical database, focused on patients with metastatic melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC) who were treated with immune checkpoint inhibitors from the time of FDA approval until 2019. The cohort for melanoma began treatment in 2012, while the RCC and NSCLC cohorts started in 2016. The findings of the study were published in JAMA Oncology on January 4.
Immunotherapy has revolutionized the field of oncology in the past decade, with a substantial improvement in survival rates for many patients treated with these drugs, noted Dr. Sajid Khan, the senior author of the study and the section chief of Hepato-Pancreato-Biliary (HPB) and Mixed Tumors at Yale School of Medicine. As a result, the application of immunotherapy has increased across the United States. The aim of our study was to examine the initiation of immunotherapy at the end of a patient’s life with metastatic cancer.
Given the relative novelty of this type of therapy, the study sought to shed light on national prescribing patterns and act as a precursor to changes in the clinical approach towards advanced cancer patients.
The study included 20,415 stage IV melanoma patients, 197,331 stage IV NSCLC patients, and 24,625 stage IV RCC patients. Researchers took various factors into account, such as the age, sex, race, and ethnicity of each patient, as well as the location of metastases and the healthcare facility where treatment was administered.
Dr. Khan explained the team’s interest in determining the frequency of immunotherapy initiation within the last 30 days of a patient’s life. According to their findings, the initiation of immunotherapy in the final month of a patient’s life has significantly increased in the last decade, comprising one in every 14 immunotherapy treatments overall.
In the case of metastatic melanoma patients, the increase was from 0.8% to 4.3%, while for NSCLC patients, it rose from 0.9% to 3.2%, and for RCC patients, it went up from 0.5% to 2.6%. In 2019, these end-of-life-initiated (EOL-I) treatments represented 7.3% of all immunotherapy treatments, indicating a growing trend in the application of EOL-I immunotherapy.
The location where patients received immunotherapy made a difference in their survival outcomes. Dr. Khan stated that there were improved survival rates when the therapy was administered at academic and high-volume hospitals. Patients treated at non-academic or low-volume hospitals were more likely to receive EOL-I immunotherapy, but they had lower chances of dying when given immunotherapy for metastatic cancers at academic and high-volume hospitals.
Another significant finding was that the outcome for patients who received immunotherapy towards the end of their life was influenced by the burden of metastasis. Patients with more than three sites of distant metastases had a higher likelihood of dying within one month of initiating immunotherapy compared to those with only distant lymph node metastasis.
The researchers emphasized that immunotherapy offers a substantial benefit in overall survival and can potentially save patients with metastasis, even those in high-risk sub-groups. The study’s findings underscore the need for further investigation into the implications of EOL-I immunotherapy, with the hope of refining treatment guidelines for the well-being of patients facing metastatic cancer.
The study’s first author was Daniel Kerekes from Yale School of Medicine and Yale Department of Surgery. Other Yale co-authors included Alexander Frey, Elizabeth Prsic, Thuy Tran, James Clune, Mario Sznol, Harriet Kluger, Howard Forman, Robert Becher, and Kelly Olino.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
