Journal of Translational Medicine (Jun 2021)
PD-1/PD-L1 checkpoint inhibitors during late stages of life: an ad-hoc analysis from a large multicenter cohort
- Daniele Santini,
- Tea Zeppola,
- Marco Russano,
- Fabrizio Citarella,
- Cecilia Anesi,
- Sebastiano Buti,
- Marco Tucci,
- Alessandro Russo,
- Maria Chiara Sergi,
- Vincenzo Adamo,
- Luigia S. Stucci,
- Melissa Bersanelli,
- Giulia Mazzaschi,
- Francesco Spagnolo,
- Francesca Rastelli,
- Francesca Chiara Giorgi,
- Raffaele Giusti,
- Marco Filetti,
- Paolo Marchetti,
- Andrea Botticelli,
- Alain Gelibter,
- Marco Siringo,
- Marco Ferrari,
- Riccardo Marconcini,
- Maria Giuseppa Vitale,
- Linda Nicolardi,
- Rita Chiari,
- Michele Ghidini,
- Olga Nigro,
- Francesco Grossi,
- Michele De Tursi,
- Pietro Di Marino,
- Laura Pala,
- Paola Queirolo,
- Sergio Bracarda,
- Serena Macrini,
- Stefania Gori,
- Alessandro Inno,
- Federica Zoratto,
- Enrica T. Tanda,
- Domenico Mallardo,
- Maria Grazia Vitale,
- Thomas Talbot,
- Paolo A. Ascierto,
- David J. Pinato,
- Corrado Ficorella,
- Giampiero Porzio,
- Alessio Cortellini
Affiliations
- Daniele Santini
- Medical Oncology, Campus Bio-Medico University
- Tea Zeppola
- Medical Oncology, Campus Bio-Medico University
- Marco Russano
- Medical Oncology, Campus Bio-Medico University
- Fabrizio Citarella
- Medical Oncology, Campus Bio-Medico University
- Cecilia Anesi
- Medical Oncology, Campus Bio-Medico University
- Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma
- Marco Tucci
- Medical Oncology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari
- Alessandro Russo
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina
- Maria Chiara Sergi
- Medical Oncology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari
- Vincenzo Adamo
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina
- Luigia S. Stucci
- Medical Oncology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari
- Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma
- Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma
- Francesco Spagnolo
- IRCCS Ospedale Policlinico San Martino
- Francesca Rastelli
- UOC Oncologia Ascoli Piceno – San Benedetto del Tronto
- Francesca Chiara Giorgi
- UOC Oncologia Ascoli Piceno – San Benedetto del Tronto
- Raffaele Giusti
- Medical Oncology Unit, Sant’ Andrea Hospital of Rome
- Marco Filetti
- Medical Oncology Unit, Sant’ Andrea Hospital of Rome
- Paolo Marchetti
- Medical Oncology Unit, Sant’ Andrea Hospital of Rome
- Andrea Botticelli
- Department of Clinical and Molecular Medicine, Sapienza University of Rome
- Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, “Sapienza” University of Rome
- Marco Siringo
- Medical Oncology (B), Policlinico Umberto I, “Sapienza” University of Rome
- Marco Ferrari
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana
- Riccardo Marconcini
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana
- Maria Giuseppa Vitale
- Medical Oncology, University Hospital of Modena
- Linda Nicolardi
- UOC Oncologia Padova Sud - AULSS6 Euganea
- Rita Chiari
- UOC Oncologia Padova Sud - AULSS6 Euganea
- Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico
- Olga Nigro
- Medical Oncology, ASST Sette Laghi
- Francesco Grossi
- Division of Medical Oncology, University of Insubria
- Michele De Tursi
- Department of Medical, Oral & Biotechnological Sciences, University G. D’Annunzio
- Pietro Di Marino
- Clinical Oncology Unit, S.S. Annunziata Hospital
- Laura Pala
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS
- Paola Queirolo
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS
- Sergio Bracarda
- S.C. Medical Oncology, Azienda Ospedaliera S. Maria
- Serena Macrini
- S.C. Medical Oncology, Azienda Ospedaliera S. Maria
- Stefania Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria
- Alessandro Inno
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria
- Federica Zoratto
- Medical Oncology, Santa Maria Goretti Hospital
- Enrica T. Tanda
- IRCCS Ospedale Policlinico San Martino
- Domenico Mallardo
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione “G. Pascale”
- Maria Grazia Vitale
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione “G. Pascale”
- Thomas Talbot
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital
- Paolo A. Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione “G. Pascale”
- David J. Pinato
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital
- Corrado Ficorella
- Medical Oncology Unit, St. Salvatore Hospital
- Giampiero Porzio
- Medical Oncology Unit, St. Salvatore Hospital
- Alessio Cortellini
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital
- DOI
- https://doi.org/10.1186/s12967-021-02937-9
- Journal volume & issue
-
Vol. 19,
no. 1
pp. 1 – 8
Abstract
Abstract Background The favourable safety profile and the increasing confidence with immune checkpoint inhibitors (ICIs) might have boosted their prescription in frail patients with short life expectancies, who usually are not treated with standard chemotherapy. Methods The present analysis aims to describe clinicians’ attitudes towards ICIs administration during late stages of life within a multicenter cohort of advanced cancer patients treated with single agent PD-1/PD-L1 checkpoint inhibitors in Italy. Results Overall, 1149 patients with advanced cancer who received single agent PD-1/PD-L1 checkpoint inhibitors were screened. The final study population consisted of 567 deceased patients. 166 patients (29.3%) had received ICIs within 30 days of death; among them there was a significantly higher proportion of patients with ECOG-PS ≥ 2 (28.3% vs 11.5%, p < 0.0001) and with a higher burden of disease (69.3% vs 59.4%, p = 0.0266). In total, 35 patients (6.2%) started ICIs within 30 days of death; among them there was a higher proportion of patients with ECOG-PS ≥ 2 (45.7% vs 14.5%, p < 0.0001) and with a higher burden of disease (82.9% vs 60.9%, p = 0.0266). Primary tumors were significantly different across subgroups (p = 0.0172), with a higher prevalence of NSCLC patients (80% vs 60.9%) among those who started ICIs within 30 days of death. Lastly, 123 patients (21.7%) started ICIs within 3 months of death. Similarly, within this subgroup there was a higher proportion of patients with ECOG-PS ≥ 2 (29.3% vs 12.8%, p < 0.0001), with a higher burden of disease (74.0% vs 59.0%, p = 0.0025) and with NSCLC (74.0% vs 58.8%, p = 0.0236). Conclusion Our results confirmed a trend toward an increasing ICIs prescription in frail patients, during the late stages of life. Caution should be exercised when evaluating an ICI treatment for patients with a poor PS and a high burden of disease.
Keywords