Immune checkpoint inhibitors (ICIs), a major type of cancer immunotherapy, don't do much for hospitalized cancer patients, researchers at the Icahn School of Medicine at Mount Sinai report.
Patients to whom ICIs were administered in the hospital had a median survival of only one and a half months following treatment, according to the study, titled "Inpatient Immunotherapy Outcomes Study: A Multicenter Retrospective Analysis." The first large-scale, multicenter retrospective analysis of inpatient immunotherapy, the study was published earlier this week in Journal of Clinical Oncology: Oncology Practice.
"ICIs are frequently administered to inpatients as a last-ditch effort, despite the lack of robust data supporting their benefit in this setting," said lead author Deborah Doroshow, MD, PhD, Associate Professor of Medicine (Hematology and Medical Oncology) at The Tisch Cancer Institute at Mount Sinai. "Our study provides clear evidence that most patients do not significantly benefit, and the risks may outweigh the potential rewards."
Immune checkpoint inhibitors, which help the body's immune system to recognize and destroy cancer cells and have transformed treatment for many cancer types, are often restricted for inpatient use due to high costs and lack of reimbursement. Single-center studies have previously suggested limited efficacy in hospitalized patients, but this new multicenter analysis reinforces the need for clinicians and health systems to reconsider their use based on poor clinical outcomes.
The research, conducted in collaboration with Stanford, Georgetown, Yale, and the University of Pennsylvania, analyzed data from 215 patients who received ICIs while hospitalized. The findings indicate that 25 percent of these patients died in the hospital, and only 12 percent of patients appeared to benefit from treatment. No significant clinical or demographic factors were associated with a positive response to the therapy. Dr. Doroshow noted that ICIs typically take two to six months to be effective, while many hospitalized cancer patients have life expectancies shorter than that.
These findings could influence hospital policies regarding the administration of ICIs to inpatients. While many health systems already prohibit their use due to financial constraints, this study provides clinical evidence suggesting that inpatient ICI administration should be approached with extreme caution.
"For clinicians, this serves as a reminder that even though we often hope our patient will be the exception, the reality is that very few patients benefit from inpatient ICI therapy," said Dr. Doroshow. "Families and patients should be aware that, despite the promise of immunotherapy in other settings, the likelihood of meaningful benefit in a hospital setting is very low."
About the Icahn School of Medicine at Mount Sinai
The Icahn School of Medicine at Mount Sinai is internationally renowned for its outstanding research, educational, and clinical care programs. It is the sole academic partner for the eight- member hospitals* of the Mount Sinai Health System, one of the largest academic health systems in the United States, providing care to New York City's large and diverse patient population.
The Icahn School of Medicine at Mount Sinai offers highly competitive MD, PhD, MD-PhD, and master's degree programs, with enrollment of more than 1,200 students. It has the largest graduate medical education program in the country, with more than 2,600 clinical residents and fellows training throughout the Health System. Its Graduate School of Biomedical Sciences offers 13 degree-granting programs, conducts innovative basic and translational research, and trains more than 500 postdoctoral research fellows.
Ranked 11th nationwide in National Institutes of Health (NIH) funding, the Icahn School of Medicine at Mount Sinai is among the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. More than 4,500 scientists, educators, and clinicians work within and across dozens of academic departments and multidisciplinary institutes with an emphasis on translational research and therapeutics. Through Mount Sinai Innovation Partners (MSIP), the Health System facilitates the real-world application and commercialization of medical breakthroughs made at Mount Sinai.
