Patient-Reported Outcomes for Cancer Patients Receiving Checkpoint Inhibitors: Opportunities for Palliative Care—A Systematic Review

Abstract

Context. Immune checkpoint inhibitors (ICIs) are increasingly used to treat a variety of cancers, but comparatively little is known about patient-reported outcomes (PROs) and health-related quality of life (HRQoL) among patients receiving these novel therapies.Objectives. We performed a systematic review to examine PROs and HRQoL among cancer patients receiving ICIs as compared to other anticancer therapies.Methods. We systematically searched PubMed, CINAHL, Embase, Web of Science, and Scopus, using search terms representing ICIs, PROs, and HRQoL on August 10, 2018. Eligible articles were required to involve cancer patients treated with ICIs and to report PROs and/or HRQoL data.Results. We screened 1453 references and included 15 publications representing 15 randomized controlled trials in our analysis. Studies included several cancer types (melanoma, lung cancer, genitourinary cancer, and head/neck cancer), used four different ICIs (nivolumab, pembrolizumab, atezolizumab, and ipilimumab), and compared ICIs to a wide range of therapies (chemotherapy, targeted therapies, other immunotherapy strategies, and placebo). Studies used a total of seven different PROs to measure HRQOL, most commonly the European Organisation for the Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30) (n ¼ 12, 80%). PRO data were reported in a variety of formats and at a variety of time points throughout treatment, which made direct comparison challenging. Some trials (n ¼ 11, 73%) reported PROs on specific symptoms. In general, patients receiving ICIs had similar-to-improved HRQoL and experiences when compared to other therapies.Conclusion. Despite the broad clinical trials experience of ICI therapies across cancer types, relatively few randomized studies reported PROs and patient HRQoL data. Available data suggest that ICIs are well tolerated in terms of HRQoL compared to other anticancer therapies although the conclusions are limited by the heterogeneity of trial designs and outcomes. Currently used instruments may fail to capture important symptomatology unique to ICIs, underscoring a need for PROs designed specifically for ICIs.

Health-related quality of life in cancer patients treated with immune checkpoint inhibitors: A systematic review on reporting of methods in randomized controlled trials

“…ICIs are increasingly used to treat a variety of cancers, but little is known about HRQOL. Hall et al (2019) [10] performed a systematic review to examine HRQOL among cancer patients receiving ICIs as compared to other anticancer therapies: they did not analyse investigate the HRQOL assessment methods used in RCTs on cancer patients treated with the ICIs and it is the purpose of our work.…”

“…The full search algorithm, based on Hall et al [12], used to identify potential studies in PubMed is included in S1 Search algorithm and was adapted for the other databases.…”

“…The results showed that PD-(L)1 inhibitors were associated with a consistent prolongation of the time to symptomatic deterioration [11]. Recently, Hall et al (2019), in their systematic review, suggested that ICIs are well tolerated in terms of HRQOL compared to other anticancer therapies. However, for these authors, currently used instruments may fail to capture important symptomatology unique to ICIs [12].…”

“…Recently, Hall et al (2019), in their systematic review, suggested that ICIs are well tolerated in terms of HRQOL compared to other anticancer therapies. However, for these authors, currently used instruments may fail to capture important symptomatology unique to ICIs [12]. For example, in the CheckMate141, trial of Nivolumab versus therapy of investigator's choice in recurrent or metastatic head and neck, the QLQ-H&N35 was applied to evaluate HRQOL.…”

“….ndart therapy arm (t not be covered.contsuchrash and pruritus), the most frequent irAEs with Nivolumab [8,13], are not assessed with this HRQOL measure [13]. Results of Hall et al (2019) should therefore be interpreted with caution.…”