Survivorship in immune therapy: Assessing toxicities, body composition and health-related quality of life among long-term survivors treated with antibodies to programmed death-1 receptor and its ligand
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Aim Antibodies to programmed death-1 receptor and its ligand (anti-PD-1/PD-L1) produce durable responses in many cancers. However, the long-term effects of anti-PD-1/PD-L1 blockade are not well defined. We identified the toxicities, health outcomes and health-related quality of life (HRQoL) amongst long-term survivors treated with anti-PD-1/PD-L1.Methods We assessed 217 patients who received anti-PD-1/PD-L1 for melanoma, renal cell carcinoma or non-small-cell lung carcinoma between 2009 and 2017, with survival greater than two years after treatment. Patient and tumour characteristics, immune-related adverse events (irAEs), cardiometabolic parameters (glucose, blood pressure, body mass index [BMI]), body composition (using automated body composition analyser, computed tomography and Slice-o-matic software) and HRQoL outcomes were tracked.Results Among the included patients, most were men (70.3%) and at anti-PD-1/PD-L1 initiation had an average age of 61.0 years and median BMI of 28.5. Median overall survival was not reached; 33 (15.2%) died during the follow-up primarily from progressive cancer (n = 28). At the last follow-up, most patients' Eastern Cooperative Oncology Group performance status was 0 (38%) or 1 (41%). There was no difference in blood pressure, glucose or BMI from baseline to two years after treatment initiation. Body composition showed increased adiposity (p = 0.05), skeletal muscle mass (p = 0.03) and skeletal muscle gauge (p = 0.04). We observed chronic irAEs at the last follow-up including hypothyroidism (10.6%), arthritis (3.2%), adrenal insufficiency (3.2%) and neuropathy (2.8%). New diagnoses of type 2 diabetes (6.5%) and hypertension (6.0%) were observed, with uncertain relationship to anti-PD-1/PD-L1. Patient-reported outcomes compared favourably with cancer and general populations, although younger age (p = 0.003) and need for subsequent therapy (p = 0.03) were associated with worse HRQoL outcomes.Conclusion Durable responses to anti-PD-1/PD-L1 therapy and favourable HRQoL outcomes are encouraging. Chronic events may be more common than previously thought although no clear chronic adverse cardiometabolic effects were observed.
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Patients with pre-existing autoimmune disease may have somewhat higher risk of irAEs, usually low-grade flares of their pre-existing disease rather than de novo events.
“Patients with pre-existing autoimmune disease may have somewhat higher risk of irAEs, although these usually relate to increased risks of low-grade flares of their pre-existing disease rather than de novo events.30–32”
From Endocrine toxicities of immune checkpoint inhibitors (2021) · cites this paper as [32]
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- Authors
- Patrinely, J. R., Young, A. C., Quach, H., Williams, G. R., Ye, F., Fan, R., Horn, L., Beckermann, K. E., Gillaspie, E. A., Sosman, J. A., Friedman, D. L., Moslehi, J. J., & Johnson, D. B.
- Affiliations
- Vanderbilt University (US)
- Vanderbilt University Medical Center (US)
- University of Alabama at Birmingham (US)
- Northwestern University (US)
- Corresponding author
- Patrinely, James Randall
- ORCID
- Venue
- European Journal of Cancer
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 135
- Pages
- 211-220
- ISSN
- 0959-8049 (ISSN-L)
- PMC
- PMC7374019
- OpenAlex
- W3037716626
- Cited by
- 61
- References
- 31
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 8 · 2023: 13 · 2022: 10 · 2021: 14 · 2020: 1
- FWCI
- 3.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Journal of Cancer (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- NCCN
- ACS
- NIH
- IASLC
- BMS
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Life Sciences › Immunology and Microbiology › Immunology › Immunotoxicology and immune responses
- Keywords
- immune checkpoint inhibitors, long-term survivors, immune-related adverse events, health-related quality of life, body composition, adiposity, skeletal muscle mass, type 2 diabetes, hypertension, hypothyroidism, adrenal insufficiency, neuropathy, melanoma, renal cell carcinoma, non-small cell lung cancer
- MeSH terms
- Antineoplastic Agents, Immunological, Progression-Free Survival, Immune Checkpoint Inhibitors, Functional Status, Aged, Body Composition, Female, Humans, Male, Middle Aged, Neoplasms, Nutritional Status, Quality of Life, Retrospective Studies, Time Factors, Survivors, B7-H1 Antigen, Programmed Cell Death 1 Receptor
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