Immunotherapy, Academic Centers May Decrease Mortality in Metastatic Cancer

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Some with metastatic cancers receiving end-of-life-initiated immunotherapy may have a decreased risk of mortality when treated at a high-volume facility, research found.

Patients treated with end-of-life immunotherapy tended to have better outcomes when they were treated at an academic center or a high-volume center, recent research showed.

Some patients with metastatic cancers had a decreased risk of dying within one month after end-of-life (EOL)-initiated immunotherapy at academic or high-volume centers, compared with patients treated at nonacademic or very low-volume centers, according to a recent study.

Specifically, patients with metastatic non-small cell lung cancer (NSCLC), melanoma and kidney cancer who had more comorbidities were more likely to be at higher risk for death within one month of starting immunotherapy, especially at nonacademic and very low-volume facilities, a study from JAMA Oncology determined.

The study analyzed data from 242,371 patients, of which the average age was approximately 68 years and approximately 43% of patients were aged 70 or older.

According to the study, there were 197,331 patients with metastatic NSCLC: 72% did not receive immunotherapy, 26% received non-EOL immunotherapy and 3% received EOL-initiated immunotherapy.

Of the 20,415 patients with metastatic melanoma, 57% did not receive immunotherapy; 41% received non-EOL immunotherapy and lived longer than one month after starting it; and 3% received EOL-initiated immunotherapy.

There were 24,625 patients with metastatic kidney cell carcinoma, of which 73% did not receive immunotherapy, 26% received non-EOL immunotherapy and 2% received EOL-initiated immunotherapy.

“The overall rate of immunotherapy increased for all three cancers over their respective study periods,” the researchers wrote. “The proportion of all patients who received EOL-initiated immunotherapy likewise increased over time in parallel to the increase in the overall rate of immunotherapy: from 0.8% to 4.3% for melanoma, from 0.9% to 3.2% for NSCLC and from 0.5% to 2.6% for (kidney cell carcinoma).”

Regarding factors related to death within one month of immunotherapy initiation, researchers also found that patients who received treatment at an academic or high-volume center were “associated with a significant decrease in odds of (receiving) EOL-initiated immunotherapy for all cancer types.”

Patients who were treated at one of the two facilities —an academic or a high-volume center — were 31% and 30% less likely to die within one month of immunotherapy initiation, respectively, versus patients who were treated at nonacademic or very low-volume centers.

More specifically, patients with metastatic cancer had decreased mortality when they had “greater experience, resources multidisciplinary support and access to specialized treatment” at academic and high-volume facilities that mostly treat patients with advanced disease, the researchers found.

Researchers also determined that age played a role in risk factors for EOL-initiated immunotherapy.

“Age was a risk factor for EOL-initiated immunotherapy for those with NSCLC, with age 50 to 70 years, and age older than 70 years associated with increased odds of EOL-initiated immunotherapy compared to age 50 years or younger,” the researchers wrote.

They also established that all patients regardless of cancer type, who were aged 70 or older were “significantly associated with 36% to 39% lower odds of receiving any immunotherapy” when compared with patients who were aged 50 or younger.

Socioeconomic factors, such as household income, were also significant to patients who were able to receive EOL-initiated immunotherapy, according to the study.

Immunotherapy is “one of the most expensive drugs on the market,” researchers noted, in which a single dose could range from $10,000 to $20,000, meaning the majority of patients would face financial burdens caused by medical costs, regardless of whether they were insured or not.

“More than 150 patients in this study who received EOL-initiated immunotherapy were uninsured, while more than 15% lived in a zip code with a median annual household income of less than $46,277,” the authors wrote.

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