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Effects of molecular targeting agents and immune-checkpoint inhibitors in patients with advanced cancer who are near the end of life

Published online by Cambridge University Press:  17 March 2021

Shuji Hiramoto Open the ORCID record for Shuji Hiramoto [Opens in a new window] ,
Tomohiko Taniyama ,
Ayako Kikuchi ,
Tetsuo Hori ,
Akira Yoshioka Open the ORCID record for Akira Yoshioka [Opens in a new window]  and
Akira Inoue
Shuji Hiramoto*
Affiliation:
Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital Japan, Kyoto, Japan
Tomohiko Taniyama
Affiliation:
Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
Ayako Kikuchi
Affiliation:
Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
Tetsuo Hori
Affiliation:
Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
Akira Yoshioka
Affiliation:
Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
Akira Inoue
Affiliation:
Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
*
Author for correspondence: Shuji Hiramoto, Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital Japan, Katsuragoshocho-1 Nishikyo ward, Kyoto. E-mail: otomari1rx.8@gmail.com
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Abstract

Background

In recent years, the use of both molecular targeting agents (MTAs) and immune-checkpoint inhibitors (ICIs) tend to occupy important positions in systemic anticancer therapy (SACT). The objective of this study is to describe the predictors of SACT include both MTAs and ICIs near the end of life (EOL) and the effect on EOL care in patients with advanced cancer.

Methods

We analyzed all patients who died of advanced cancer from August 2016 to August 2019, and we analyzed the survival time of patients who underwent anticancer agents excluded due to the loss of information about the last administration of SACT. The primary endpoint of this study was to identify predictors during the last administration of SACT near EOL.

Results

In a multivariate analysis, the Eastern Cooperative Oncology Group performance status (ECOG-PS) (ORs 33.781) was significantly related factors within 14 days of death from the last administration of SACT. Age (ORs 0.412), ECOG-PS (ORs 11.533), primary cancer site of upper GI cancers (ORs 2.205), the number of comorbidities (ORs 0.207), MTAs (ORs 3.139), and ICIs (ORs 3.592) were significantly related factors within 30 days of death. The median survival time (MST) of patients with PS 3–4 was 29 days, while that of patients with both PS 0–2 was 76 days. The prevalence rate of delirium with MTAs was 17.5%, which was significantly lower than that of patients without it (31.8%). The prevalence rate of the mean dose of opioids in patients with ICIs was 97.9 mg/day, which was significantly higher than that of patients without it (44.9 mg/day).

Conclusions

Age, ECOG-PS, primary cancer site, the number of comorbidities, MTAs, and ICIs use were significant associated with SACT near EOL. Information on these factors may aid clinical decision making in referral to palliative care institutes.

Keywords

End of lifeImmune-checkpoint inhibitorsMolecular targeted agentsSystemic anticancer therapy
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 6 , December 2021 , pp. 709 - 714
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

REFERENCES

Barbera, L, Paszat, L and Chartier, C (2006) Indicators of poor-quality end-of-life cancer care in Ontario. Journal of Palliative Care 22(1), 12–17.CrossRefGoogle ScholarPubMed
Braga, S, Rute Fonseca, AM, Moreira, A, et al. (2007) The aggressiveness of cancer care in the last three months of life: A retrospective single centre analysis. Psycho-Oncology 16(9), 863–868.10.1002/pon.1140CrossRefGoogle ScholarPubMed
Earle, CC, Neville, BA, Lndrum, MB, et al. (2004) Trends in aggressiveness of cancer care near the end of life. Journal of Clinical Oncology 22(2), 315–321.10.1200/JCO.2004.08.136CrossRefGoogle ScholarPubMed
Glisch, C, Hagiwara, Y, Lyckholm, L, et al. (2020) Immune checkpoint inhibitor use near the end of life. Journal of Palliative Medicine 23(7), 977–979.10.1089/jpm.2019.0383CrossRefGoogle ScholarPubMed
Hanny, A, Sonja, H and Georg, B (2014) Chemotherapy near the end of life: A retrospective single-center analysis of patients’ charts. BMC Palliative Care 13, 26.Google Scholar
Hashimoto, K, Yonemori, K, Katsumata, N, et al. (2009) Factors that affect the duration of the interval between the completion of palliative chemotherapy and death. Oncologist 14(7), 752–759.10.1634/theoncologist.2008-0257CrossRefGoogle ScholarPubMed
Hikmat, A, Omar, S, David, H, et al. (2019) Intensity of cancer care near the end of life at a tertiary care cancer center in Jordan. Journal of Pain and Symptom Management 57(6), 1106–1113.Google Scholar
Hiramoto, S, Maeda, I, Morita, T, et al. (2016) Effect of primary site on the prognosis in patients with advanced-stage cancer in palliative care settings (J-Proval): A multicenter prospective cohort study in Japan. Journal of Clinical Oncology 34(15 suppl), 10025.CrossRefGoogle Scholar
Hiramoto, S, Kato, K, Boku, N, et al. (2018) A retrospective analysis of 5-fluorouracil plus cisplatin as first line chemotherapy in the recent treatment strategy for patients with metastatic or recurrent esophageal squamous cell carcinoma. International Journal of Clinical Oncology 23(3), 466–472.10.1007/s10147-018-1239-xCrossRefGoogle ScholarPubMed
Hiramoto, S, Hori, T, Inoue, A, et al. (2019) Prognostic factors in patients who received end-of-life chemotherapy for advanced cancer. International Journal of Clinical Oncology 24(4), 454–459.10.1007/s10147-018-1363-7CrossRefGoogle ScholarPubMed
Hui, D, Meghan, S, Bruera, E, et al. (2013) Targeted agent use in cancer patients at the end-of-life. Journal of Pain and Symptom Management 46(1), 1–8.10.1016/j.jpainsymman.2012.07.007CrossRefGoogle ScholarPubMed
Inoue, SK, van Dyck, CH, Alessi, CA, et al. (1990) Clarifying confusion: The confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine 113(12), 941–948.10.7326/0003-4819-113-12-941CrossRefGoogle Scholar
Inoue, A, Kobayashi, K, Usui, K, et al. (2009) First line gefitinib for patients with advanced non-small-cell lung cancer harboring epidermal growth factor receptor mutations without indication for chemotherapy. Journal of Clinical Oncology 27(9), 1394–1400.10.1200/JCO.2008.18.7658CrossRefGoogle ScholarPubMed
Kao, S, Shafig, J, Adams, D, et al. (2009) Use of chemotherapy at end of life in oncology patients. Annals of Oncology 20(9), 1555–1559.10.1093/annonc/mdp027CrossRefGoogle ScholarPubMed
Maltoni, M, Scarpi, E, Nanni, O, et al. (2016) Systematic versus on-demand early palliative care: A randomized clinical trial assessing quality of care and treatment aggressiveness near the end-of-life. European Journal of Cancer 69, 110–118.CrossRefGoogle ScholarPubMed
Morita, T, Bito, S, Uchitomi, Y, et al. (2005) Development of a clinical guideline for palliative sedation therapy using the Delphi method. Journal of Palliative Medicine 8(4), 716–729.10.1089/jpm.2005.8.716CrossRefGoogle ScholarPubMed
Näppä, U, Lindqvist, O, Rasmussen, BA, et al. (2011) Palliative chemotherapy during the last month of life. Annals of Oncology 22(11), 2375–2380.10.1093/annonc/mdq778CrossRefGoogle ScholarPubMed
Petra, G, Aynharan, S, Theresas, T, et al. (2015) Variations in intensity of end-of-life cancer therapy by cancer type at a Canadian tertiary cancer centre between 2003 and 2010. Supportive Care in Cancer 23(10), 3059–3067.Google Scholar
Prigerson, HG, Bao, Y, Shah, M, et al. (2015) Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncology 1(6), 778–784.10.1001/jamaoncol.2015.2378CrossRefGoogle ScholarPubMed
Schinipper, LE, Smith, TJ, Raghavan, D, et al. (2012) American society of clinical oncology identifies five key opportunities to improve care and reduce costs: The top five list for oncology. Journal of Clinical Oncology 30(14), 1715–1724.10.1200/JCO.2012.42.8375CrossRefGoogle Scholar
Tsai, H-Y, Chung, K-P and Kuo, RN-C (2018) Impact of targeted therapy on the quality of end-of-life care for patients with non-small-cell lung cancer. Journal of Pain and Symptom Management 55(3), 798–807.10.1016/j.jpainsymman.2017.10.009CrossRefGoogle ScholarPubMed
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