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Year : 2018  |  Volume : 17  |  Issue : 1  |  Page : 1-13

Immune checkpoint inhibitors and health-related quality of life: A systematic review of the current literature

Faculty of Medicine, Mansoura University, Mansoura, Egypt

Correspondence Address:
Mohamed H Elshahidi
Algomhorria Street, Mansoura, Dakahliya
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/MJ.MJ_19_18

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Background: Over the past years, some immune checkpoint inhibitors (ICPIs) have been approved for clinical use in several malignancies. Examining the effects of ICPIs on the patients' health-related quality of life (HRQoL) may help clinicians in their decision-making process. Aim: The aim of this review is to summarize the current evidence about the effects of ICPIs on the patients' HRQoL. Methods: PubMed, Embase (via OvidSP), Web of Science, Scopus, and EBSCOhost were searched from their dates of inception to January 2018. Studies reporting the effects of ICPIs on the HRQoL using a valid questionnaire are included in the review. A narrative summary of the included studies was presented. Results: Sixteen studies met the specific inclusion criteria, which are as follows: seven about melanoma, three about renal cell carcinoma (RCC), one about metastatic Merkel-cell carcinoma (mMCC), two about squamous cell carcinoma of the head and neck, two about non-small-cell lung cancer (NSCLC), and one about colorectal cancer (CRC). In melanoma, more improvements in the global health status (GHS) were observed with pembrolizumab, ipilimumab 3 mg/kg, and pembrolizumab every 2 weeks than with ipilimumab, ipilimumab 10 mg/kg, and pembrolizumab every 3 weeks, respectively. However, no clinically significant differences were found when adding gp100 vaccine, using different doses of pembrolizumab or combining ICPIs. In RCC, the EQ-5D utility index and the time to deterioration were improved in the nivolumab groups than in everolimus groups. In squamous cell carcinoma of the head and neck, the GHS remained stable or improved with nivolumab. However, there was no significant difference in the time to deterioration between nivolumab and investigator's choice. In mMCC, a slight gain in the GHS was observed with avelumab. In NSCLC, improvements were observed in the symptoms scales and some of the functioning scales with pembrolizumab than chemotherapy. However, no difference was observed between them on emotional functioning. In CRC, some clinically meaningful improvements were observed in nivolumab plus ipilimumab. Conclusion: Due to the complexities in the longitudinal analysis of HRQoL data and some other concerns in the included studies designs, these results should be interpreted carefully. PROSPERO registration number: CRD42018089311

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