Researchers Highlight Need for Tailored HRQOL Measures for Patients Receiving Immunotherapy

Jaime Rosenberg

As a validated health-related quality of life (HRQOL) measurement is not widely used among patients receiving this type of treatment, trials take advantage of traditional HRQOL tools.

Amidst a push to better incorporate patient-reported outcomes in cancer care and the continued widespread adoption of immunotherapy across various types of cancer, researchers highlighted the need for newer, validated measures of health-related quality of life (HRQOL) that are tailored to patients receiving immunotherapy.

In a recent paper, researchers noted 2 specific challenges, including:

  • The need for possible symptomatic immune-related adverse events (irAEs) from immunotherapy treatment to be identified and incorporated into patient-reported outcome measures
  • The need for patient input to confirm that specific irAEs impact HRQOL and subsequent adoption of measures specific to different types of immunotherapies

There is currently no widespread use of a validated HRQOL measurement tool for patients receiving this type of treatment, meaning traditional HRQOL tools, such as the Functional Assessment of Cancer Therapy-General (FACT-G) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), are used instead.

“The past few years have seen the development and approval of many different immune-oncology (IO) therapies that differ from traditional cytotoxic treatments in their mechanism of action, effectiveness, administration, and particularly their side-effect profiles,” explained the researchers.

“It is not known if general HRQOL tools like FACT-G and EORTC QLQ-C30 are sufficiently sensitive to measure HRQOL in IO-treated patients,” they said. “What is clear is that irAEs can impact HRQOL; thus, these symptomatic adverse events should be included in any tool that purports to measure HRQOL in IO-treated patients.”

According to the researchers, most immunotherapy trials that have assessed HRQOL used EORTC QLQ-C30, finding that QOL was either improved or maintained with IO therapy either alone or in combination. Compared with chemotherapy alone, a combination of immunotherapy and chemotherapy also improved HRQOL.

However, while the findings were statistically significant, just a few reached the predetermined clinically meaningful change from baseline. For example, the Checkmate-101, comparing nivolumab and the investigator’s choice of treatment, showed that although there was a drop in HRQOL among those receiving the investigator’s choice, patients receiving nivolumab did not achieve a clinically meaningful difference in improvement based on the EORTC QLQ-30.

The researchers noted several initiatives are currently underway to address the gaps highlighted in the paper, including one from the Lung Cancer Registry, which has initiated a voluntary, self-reported registry for patients with lung cancer to report side effects of immunotherapy and HRQOL, in addition to demographic and clinical information.

Reference: Voon PJ, Cella D, and Hansen AR. Health-related quality-of-life assessment of patients with solid tumors on immuno-oncology therapies. Cancer. Published online March 4, 2021. doi:10.1002/cncr.33457