Nieder Carsten, Reigstad Anne, Carlsen Espen A, Flatøy Liv, Tollåli Terje
Oncology, Nordland Hospital Trust, Bodø, NOR.
Internal Medicine, Nordland Hospital Trust, Bodø, NOR.
Cureus. 2020 Feb 18;12(2):e7030. doi: 10.7759/cureus.7030.
Objective The aim of this study was to investigate the patterns of palliative care, terminal care, and hospital deaths in deceased patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICI). Methods This study involves a retrospective analysis of a group of 32 patients treated with first- or second-line ICI regimens. The group was compared with a matched contemporary cohort of patients who received systemic treatment that did not include an ICI. The 1:1 matching was based on sex, age, stage of cancer (IV versus lower), and initial treatment after diagnosis (locoregional versus systemic). Results The median overall survival from diagnosis was 9.8 months [95% confidence interval (CI): 7.4-12.2 months] in the non-ICI patients and 11.6 months (95% CI: 5.9-17.3 months) in the ICI group (p: 0.09). Death resulting from toxicity was recorded in two patients (non-ICI) and one patient (ICI), respectively (p: 0.8). Hospital death was more common after ICI (19 versus 11 patients, p: 0.08). During the last three months of life, non-ICI patients spent a median of 11 days (range: 0-28) in the hospital, compared with 20 days (range: 0-45) for ICI patients (p: 0.005). More ICI patients (21 versus 14) received systemic therapy during the last three months of life (p: 0.13). However, treatment rates during the last four weeks were comparable (eight non-ICI and six ICI patients, respectively; p: 0.8). Conclusion We did not identify any concerns regarding the fatal toxicity of ICI treatment. Due to several different baseline parameters, there are reasons to believe that hospitalization and hospital death in the ICI group were mainly related to unevenly distributed disease characteristics and not to ICI administration itself. Since real-world data from rural patient cohorts might differ from those obtained in clinical trials, it is necessary to conduct additional and larger studies about ICI-associated patterns of terminal care.
目的 本研究旨在调查接受免疫检查点抑制剂（ICI）治疗的非小细胞肺癌（NSCLC）死亡患者的姑息治疗、终末期护理及医院死亡模式。方法 本研究对一组32例接受一线或二线ICI方案治疗的患者进行回顾性分析。将该组患者与同期接受不包括ICI的全身治疗的匹配队列患者进行比较。1:1匹配基于性别、年龄、癌症分期（IV期与更低分期）以及诊断后的初始治疗（局部区域治疗与全身治疗）。结果 非ICI组患者从诊断开始的中位总生存期为9.8个月[95%置信区间（CI）：7.4 - 12.2个月]，ICI组为11.6个月（95%CI：5.9 - 17.3个月）（p值：0.09）。分别有2例（非ICI组）和1例（ICI组）患者记录为由毒性导致的死亡（p值：0.8）。ICI治疗后医院死亡更为常见（19例与11例患者，p值：0.08）。在生命的最后三个月，非ICI组患者在医院的中位停留时间为11天（范围：0 - 28天），而ICI组患者为20天（范围：0 - 45天）（p值：0.005）。更多ICI组患者（21例与14例）在生命的最后三个月接受了全身治疗（p值：0.13）。然而，在生命的最后四周治疗率相当（分别为8例非ICI组患者和6例ICI组患者；p值：0.8）。结论 我们未发现关于ICI治疗致命毒性的任何问题。由于存在几个不同的基线参数，有理由认为ICI组的住院和医院死亡主要与疾病特征分布不均有关，而非与ICI给药本身有关。由于农村患者队列的真实世界数据可能与临床试验中获得的数据不同，有必要针对ICI相关的终末期护理模式进行更多更大规模的研究。
