Reasons for Treatment Discontinuation and Their Effect on Outcomes of Immunotherapy in Southwest Finland: A Retrospective, Real-World Cohort Study

Abstract

Simple Summary Currently, immune checkpoint inhibitors are the backbone of treatment for multiple different types of advanced cancer in routine clinical practice. However, most patients still discontinue treatment due to disease progression, and some patients discontinue treatment after severe immune-related adverse events. We aimed to evaluate the reasons for treatment discontinuation in adult patients with advanced cancer (mainly non-small cell lung cancer, melanoma, and kidney cancer) who had received immune checkpoint inhibitors in the first-line or later treatment lines outside clinical trials in Southwest Finland. In this study, it was found that disease progression was the most common reason for treatment discontinuation (in 62% of the patients) followed by immune-related adverse events (17%) and disease control or radiological response (12%). The patients who discontinued treatment due to immune-related adverse events and disease control or radiological response had favorable treatment outcomes, and 46% of them remained alive and progression-free during follow-up.Abstract Immune checkpoint inhibitors (ICI) have improved survival in several cancer types. Still, most patients develop disease progression during or after treatment. We evaluated the reasons for treatment discontinuation and their effect on treatment outcomes in adult patients with advanced cancer with ICI in the first or later treatment lines in Southwest Finland between 1 January 2015 and 31 December 2021. Baseline characteristics and treatment outcomes were retrospectively obtained from the electronic medical records. There were 317 patients with 15 different cancer types, most commonly non-small cell lung cancer, melanoma, and kidney cancer, treated with ICI outside clinical trials. During follow-up, 94% of the patients had discontinued treatment. A total of 62% was due to disease progression, 17% due to immune-related adverse events (irAEs), 12% after achieving disease control or radiological response, and 9% due to poor performance status. The median progression-free survival (mPFS) was 5.4 months and the median overall survival (mOS) was 20.3 months in the whole cohort. Longer mPFS and mOS were observed in patients who discontinued ICI due to irAEs (24.3 and 49.2 months) and after disease control (49.7 months and not reached). In total, 46% of the patients who discontinued ICI after irAEs or disease control remained alive and progression-free during follow-up.