Optimizing the use of immune checkpoint inhibitors in cancer care

Cancer remains a leading cause of death and disease globally, with its incidence projected to rise in the coming years. Beyond its profound impact on the welfare of affected patients, cancer imposes vast financial costs on a societal level. Immune checkpoint inhibitors (ICIs) have revolutionized modern cancer care, establishing durable treatment responses across cancer types and improving the survival of patients. However, both optimal patient selection and treatment duration remain unclear because response rates are modest, with only approximately 20-40% of patients experiencing benefits from ICI treatments.

The economic challenges presented by ICIs are significant; they are among the most expensive cancer treatments currently available in clinical use, raising concerns regarding their cost-effectiveness due to limited response rates. Assessing the financial implications of ICIs requires careful evaluation of patient selection, treatment duration, and adverse effect management. Thus far, the optimal patient population for ICIs remains undefined; only a few clinically relevant predictive biomarkers have been identified, and their negative predictive values are rather low. Consequently, determining the optimal treatment durations is critical to reduce excessive treatment, limiting both the financial and clinical toxicity of the treatment. ICI-related toxicities present considerable challenges to both treatment tolerability and financial impact because therapy-related toxicities are diverse in variety and prevalence, highlighting the importance of prompt recognition and proper management.

This doctoral research explores ways to optimize the use of ICI therapies and aims to generate tools for a financially sustainable therapeutic approach by evaluating patient selection, treatment duration, and ICI treatment in relation to toxicities in a real-world context.