Retrospective cohort study of immunotherapy initiation at the end of life in patients with metastatic cancer in the US

While immunotherapy is being used in an expanding range of clinical scenarios, the incidence of immunotherapy initiation within one month before the end of life (EOL-I) is unknown. A retrospective cohort study using the National Cancer Database investigated the incidence of EOL-I among patients with metastatic melanoma, non-small cell lung cancer (NSCLC) or renal cell carcinoma (RCC) diagnosed after the FDA approval of immune checkpoint inhibitors for each diseas through 2019. The percentage of patients who received EOL-I immunotherapy increased over time for all three cancers. More than 1 in 14 immunotherapy treatments in 2019 were initiated within 1 month of death. Treatment at an academic or high-volume center rather than a nonacademic over very low-volume center was associated with decrease in odds of death within a month of iniating immunotherapy (OR 0.69; p<0.001 and OR 0.70; p<0.001, respectively). The authors conclude that the study shows that initiation of immunotherapy at the end of life is increasing over time.