Real-world perspectives on cancer patients receiving immune checkpoint inhibitor therapies

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Oulu University Hospital, Auditorium 7

Topic of the dissertation

Real-world perspectives on cancer patients receiving immune checkpoint inhibitor therapies

Doctoral candidate

Medical Doctor Sanna Iivanainen

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Cancer Research and Translational Medicine Research Unit

Subject of study

Medical Oncology

Opponent

Docent Vesa Kataja, Central Finland Central Hospital

Custos

Docent Jussi Koivunen, Oulu University Hospital

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Real-world perspectives on cancer patients receiving immune checkpoint inhibitor therapies

Cancer is one of the leading causes of death and disease worldwide. Not only does cancer have enormous effect on the health of patients and survivors but it has a tremendous financial impact on society level. In the near future, the number of new cancer cases is expected to go up mostly because of the aging of the population.

Progress in the field of immuno-oncology has changed the treatment landscape of cancer. Despite the continuously evolving indications of immune checkpoint inhibitors (ICIs), clinical knowledge about their efficacy and tolerability in real-world setting is scarce. Typically, responses are seen in a minority of the patients treated with ICIs yet most fail to respond. ICIs differ from traditional cancer therapies with potential severe side-effects rising from all the organs of the body and late timing of the side-effect occurrence, thus, there is a need for comprehensive and long-lasting assessment of symptoms.

From clinical perspective, constantly expanding indications together with rather high expenses of ICIs, while the optimal length of PD-(L)1-inhibitors remains undetermined, and selective or predictive biomarkers of response to therapy are scarce, is challenging.

This present study aims to evaluate the optimal treatment duration of PD-(L)1-inhibitors, to seek predictive factors for therapy selection, and to investigate the feasibility and clinical relevance of electronic patient-reported outcome (PRO) symptom follow-up on cancer patients receiving immune checkpoint inhibitors in real-life. In our retrospective study we showed that some patients can experience long term tumor responses even after a short (6 months) anti-PD-1 treatment period suggesting that similar outcomes can be achieved with economically more sustainable therapeutic approach.

The results also suggested a very strong negative prognostic role of elevated pre-therapy C-reactive protein (CRP) in PD-1 inhibitor treated patients. Our conclusion was that pretreatment CRP value could prove to be a cheap and non-invasive prognostic marker and that its’ possible predictive value should be investigated in prospective clinical trials. Based on our studies, ePRO follow-up of cancer patients receiving ICIs is feasible, the investigated ePRO tool is warrant, and patient adherence and satisfaction of the follow-up was very good. Furthermore, some of the PROs correlated with treatment benefit suggesting that individual prediction models for treatment benefit could be generated utilizing artificial intelligence (AI)-based algorithms.
Last updated: 24.1.2020