Abstract
Background
Limited knowledge exists regarding psychological issues and neurocognitive functioning (NCF) in long-term survivors (LTS) treated with immune checkpoint blockade (ICB). We present a cross-sectional analysis of LTS in an ongoing cohort study.
Methods
Patients (pts) diagnosed with an unresectable stage III/IV solid tumor, who initiated ICB at least one year prior to inclusion and who were in complete remission (CR) were eligible. In this interim-analysis, LTS who started ICB at least 5 years prior to inclusion were analyzed. Objective NCF was assessed using COGBAT® and converted into age and education adjusted z-scores. Neurocognitive impairment (NCI) was defined per International Cancer and Cognition Task Force guidelines. Cognitive complaints (CC), anxiety, depression, fear of cancer recurrence (FCR), and fatigue were measured using patient-reported outcome measures. Linear regression, a correlation analysis and an independent t-test were conducted.
Results
From Jul 2022 to Oct 2023, 40 LTS were enrolled (36 melanoma, 2 MSI-H colon carcinoma, 2 non-small cell lung carcinoma; med age (60y [34-92]; 21 male; 35 (88%) stage IV disease; 7 (18%) with history of brain metastasis; med time since CR 5.9y [1.4-13.3]; med time since first ICB administration 7.3y [5.0-14.4]). Objective NCI was present in 20 out of the 39 pts (51%; one pt did not complete NCF testing). We established clinical FCR in 55% and elevated levels of fatigue, anxiety, depression, CC in resp. 30%, 28%, 15% and 18%. Age (β=-.678) and education (β=.262) predicted objective NCF significantly. In contrast, CC, anxiety, depression, fatigue, brain metastasis, gender, physical activity, or cardiovascular comorbidity did not predict objective NCF. For CC, anxiety was a significant predictor (β=.618), but not fatigue, depression, brain metastasis, gender, age, physical activity, cardiovascular comorbidity, or objective NCF. No age or gender differences were found in FCR.
Conclusions
Half of the LTS treated with ICB experienced clinical FCR and objective NCI. Age and education predicted NCF, while anxiety predicted CC. These findings highlight ongoing psychological and NCF challenges of pts benefitting from a long-term remission following ICB.
Limited knowledge exists regarding psychological issues and neurocognitive functioning (NCF) in long-term survivors (LTS) treated with immune checkpoint blockade (ICB). We present a cross-sectional analysis of LTS in an ongoing cohort study.
Methods
Patients (pts) diagnosed with an unresectable stage III/IV solid tumor, who initiated ICB at least one year prior to inclusion and who were in complete remission (CR) were eligible. In this interim-analysis, LTS who started ICB at least 5 years prior to inclusion were analyzed. Objective NCF was assessed using COGBAT® and converted into age and education adjusted z-scores. Neurocognitive impairment (NCI) was defined per International Cancer and Cognition Task Force guidelines. Cognitive complaints (CC), anxiety, depression, fear of cancer recurrence (FCR), and fatigue were measured using patient-reported outcome measures. Linear regression, a correlation analysis and an independent t-test were conducted.
Results
From Jul 2022 to Oct 2023, 40 LTS were enrolled (36 melanoma, 2 MSI-H colon carcinoma, 2 non-small cell lung carcinoma; med age (60y [34-92]; 21 male; 35 (88%) stage IV disease; 7 (18%) with history of brain metastasis; med time since CR 5.9y [1.4-13.3]; med time since first ICB administration 7.3y [5.0-14.4]). Objective NCI was present in 20 out of the 39 pts (51%; one pt did not complete NCF testing). We established clinical FCR in 55% and elevated levels of fatigue, anxiety, depression, CC in resp. 30%, 28%, 15% and 18%. Age (β=-.678) and education (β=.262) predicted objective NCF significantly. In contrast, CC, anxiety, depression, fatigue, brain metastasis, gender, physical activity, or cardiovascular comorbidity did not predict objective NCF. For CC, anxiety was a significant predictor (β=.618), but not fatigue, depression, brain metastasis, gender, age, physical activity, cardiovascular comorbidity, or objective NCF. No age or gender differences were found in FCR.
Conclusions
Half of the LTS treated with ICB experienced clinical FCR and objective NCI. Age and education predicted NCF, while anxiety predicted CC. These findings highlight ongoing psychological and NCF challenges of pts benefitting from a long-term remission following ICB.
| Original language | English |
|---|---|
| Article number | S1004 |
| Number of pages | 1 |
| Journal | Annals of Oncology |
| Volume | 35 |
| DOIs | |
| Publication status | Published - Sep 2024 |