Poor Outcomes Seen in Advanced Cancer Patients Treated With Inpatient ICI Therapy

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The initiation or continued use of immune checkpoint inhibitor (ICI) treatment in an inpatient setting is associated with poor clinical outcomes in patients with advanced cancer, according to research presented at the 2022 ASCO Quality Care Symposium.

In a cohort of 159 patients who received inpatient ICI treatment, 27% died while still in hospital. The median overall survival was 47 days for the entire cohort. 

“This preliminary data is concerning for poor patient outcomes, and this should give all of us pause when we’re considering use of inpatient immune checkpoint inhibitor therapy,” said Fauzia Riaz, MD, of Stanford University in California, who presented this study at the meeting.

The retrospective study included data from 159 patients treated with an ICI during an inpatient stay between 2012 and 2021. Data were manually taken from electronic medical records.

The median age of the cohort was 61 years, and 38% were women. A majority of patients (55%) were White, 18% were Black, 8% were Asian, and 13% were Hispanic or Latino. Patients had private/commercial insurance (40%), Medicare (35%), Medicaid (18%), and other insurance (7%).

The most common cancers were thoracic or head and neck cancers (27%), followed by gastrointestinal cancers (20%), hematologic malignancies (18%), genitourinary cancers (17%), and melanoma (11%). 

For 73% of patients, ICIs were first initiated during their inpatient stay. The remaining 27% of patients continued a regimen that was started when they were outpatients. 

Nearly half of patients (47%) were discharged to home, but 27% died during their inpatient stay, 15% were discharged to a rehabilitation center, and 10% were referred to hospice. 

The median overall survival was 47 days from the first dose of ICI during the inpatient stay.

“We need further studies to better understand the impact of [inpatient] immune checkpoint inhibitors,” Dr Riaz concluded. She said researchers are currently evaluating factors that may be associated with overall survival in this population.

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