Philips Ashwin Oommen, Cyriac Sunu, Unnikrishnan P, Jose Anil T, Rathnam Krishnakumar, Saju S V, Kayal Smita, Panda Soumya Surath, Moharana Lalatendu, Kilaru Sindhu, Sehrawat Amit, Sundriyal Deepak, Dhamija Puneet, Jain Deepak, K Pamela Alice, Sachdeva Jaineet, Batta Nishant, Arora Raman, Arora Yogesh, Singh Harpreet, Anand Mridul, Sharma Ishu, Ganesan Prasanth
Department of Medical Oncology, Christian Medical College & Hospital, Ludhiana, Punjab, India.
Department of Medical Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.
South Asian J Cancer. 2024 Apr 12;14(1):77-80. doi: 10.1055/s-0044-1785460. eCollection 2025 Jan.
Using immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, but access and affordability remain significant challenges, particularly in resource-constrained settings. This multicenter study evaluated the utilization, outcomes, and challenges associated with ICIs in India. Data from multiple centers involving patients treated between January 2018 and December 2021 were retrospectively collected. Patient demographics, treatment indications, biomarker testing, financial coverage, toxicity, treatment discontinuation, clinical benefit, progression-free survival (PFS), and overall survival (OS) were analyzed. Ninety-one patients were analyzed; lung cancer (39.6%) and renal cancer (11%) were the main indications for ICI use. Programmed death ligand 1 expression was tested in 40.7% and tumor mutational burden in 3.3%. Financial constraints influenced 41.8% of patients with out-of-pocket expenses. Treatment discontinuation due to financial constraints occurred in 17.6%, with 50% showing ongoing responses. The median number of cycles was 4; the median PFS was 4.6 months, and the median OS was 15.4 months. The lung cancer cohort had a median PFS of 5.7 months and a 1-year OS of 57.6%. Limited biomarker testing and 6.6% grade ¾ toxicities were observed. This study revealed challenges in ICI utilization in resource-constrained settings driven by financial constraints. Compared with prior studies, improved outcomes reflect better patient selection and evolving understanding of ICI use. However, in the absence of biosimilars, cost remains a significant barrier. Solutions to increase access include using lower doses, which may be as effective.
使用免疫检查点抑制剂（ICI）彻底改变了癌症治疗方式，但药物可及性和可负担性仍然是重大挑战，尤其是在资源有限的环境中。这项多中心研究评估了印度ICI的使用情况、治疗结果及相关挑战。回顾性收集了2018年1月至2021年12月期间多个中心接受治疗患者的数据。分析了患者人口统计学、治疗指征、生物标志物检测、医保覆盖情况、毒性反应、治疗中断情况、临床获益、无进展生存期（PFS）和总生存期（OS）。共分析了91例患者；肺癌（39.6%）和肾癌（11%）是使用ICI的主要指征。40.7%的患者检测了程序性死亡配体1表达，3.3%的患者检测了肿瘤突变负荷。经济限制影响了41.8%需自掏腰包的患者。17.6%的患者因经济限制而中断治疗，其中50%仍有持续缓解。中位治疗周期数为4个；中位PFS为4.6个月，中位OS为15.4个月。肺癌队列的中位PFS为5.7个月，1年OS为57.6%。观察到生物标志物检测有限，且有6.6%的患者出现3/4级毒性反应。这项研究揭示了在资源有限环境中ICI使用因经济限制而面临的挑战。与先前研究相比，改善的治疗结果反映了更好的患者选择以及对ICI使用不断发展的认识。然而，在没有生物类似药的情况下，成本仍然是一个重大障碍。增加可及性的解决方案包括使用较低剂量，其可能同样有效。
