Immune Checkpoint Inhibitor Use Near the End of Life: A Single-Center Retrospective Study.

Abstract

<b><i>Background:</i></b> Immune checkpoint inhibitors (ICIs) have revolutionized treatment for many patients with advanced cancer. Little is known about ICI use near the end of life. <b><i>Objective:</i></b> To describe ICI use near the end of life. <b><i>Design:</i></b> Retrospective study of patients who received ICIs and died. <b><i>Setting/Subjects:</i></b> Patients treated with ICIs who died between August 2014 and December 2018 (<i>N</i> = 441) at the University of Iowa. <b><i>Measurements:</i></b> Comparisons were made between patients who received ICIs ≤30 days versus patients who received ICIs >30 days before death. The same analysis was done using a cutoff of 90 days. <b><i>Results:</i></b> Two hundred ninety-four (67%) patients received ICIs in the last 90 days of life and 117 (27%) patients received ICIs in the last 30 days of life. Patients who received ICIs in the last 30 days of life received fewer mean doses and more often ≤3 total doses. They also had higher mean Eastern Cooperative Oncology Group (ECOG) scores, more patients with ECOG ≥3, higher rates of dying in the hospital, and lower hospice enrollment. Patients treated with ICIs in the last 90 days of life received fewer doses, more often ≤3 total doses, had a higher mean ECOG score, more patients with ECOG ≥3, and lower hospice enrollment. $7.1 million USD was spent on ICI medications in the last 90 days of life. <b><i>Conclusion:</i></b> ICI use near the end of life is associated with poor performance status, lower hospice enrollment, dying in the hospital, financial toxicity, and minimal clinical benefit.