An Analysis of 30-Day Mortality after the Last Cycle of Immune Checkpoint Inhibitors Treatment

Background Immune checkpoint inhibitors (ICIs) have been increasingly used for patients with advanced incurable cancer, although the criteria of interruption has not been established. According to the proposition from 2011 national cancer strategy for England, 30-day mortality might be as a potential national clinical indicator of avoidable harm of systemic anticancer therapy (SACT). In this study, we investigated the details of patients who died within 30 days after the last cycle of ICIs treatment. Methods The data of all oncologic patients who received SACT between January 2016 and June 2018 were collected retrospectively. The characteristics of the patients who died within 30 days after ICIs were compared with patients who died within 30 days after conventional SACT mainly consisting of cytotoxic agents (non-ICIs). Users of oral anticancer drugs and local artery or intrathecal injections were excluded from this study. Results Of 1442 patients who received SACT, 90 patients were treated with ICIs as the final regimen. 15 patients (16.7%) died within 30 days after the last cycle of ICIs. The mortality of ICIs was higher than 22 patients (1.6%) that used non-ICIs regimen. The characteristics were as follows: median age (interquartile range); 71 years old (60-86), sex male/female; 14/1, performance status (PS) 0-1/2-4 at the last cycle; 4/11. The reasons for death were tumor progression 11, infection 3, immune related hepatitis 1, primary region; lung cancer 12, head and neck 2, melanoma 1. Among them, the proportion of PS2-4 and the expense in ICIs users were significantly higher than that in non-ICIs users (p = 0.040 and p Conclusion It is possible that ICIs continued to be used in frail patients who could not tolerate cytotoxic agents and should be offered best supportive care. Moreover, the last cycle of ICIs gave a poor cost performance. PS2-4 might be a clinical indicator as decision support for interruption of ICIs treatment at the end of life.