Incidence of fatigue associated with immune checkpoint
inhibitors in patients with cancer: a meta-analysis

J 2022

Incidence of fatigue associated with immune checkpoint inhibitors in patients with cancer: a meta-analysis

KISS, Igor, Matyáš KUHN, K. HRUSAK and T. BUCHLER

Basic information

Original name

Incidence of fatigue associated with immune checkpoint inhibitors in patients with cancer: a meta-analysis

Authors

KISS, Igor (203 Czech Republic, belonging to the institution), Matyáš KUHN (203 Czech Republic, belonging to the institution), K. HRUSAK (203 Czech Republic) and T. BUCHLER (203 Czech Republic)

Edition

ESMO OPEN, AMSTERDAM, ELSEVIER, 2022, 2059-7029

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30204 Oncology

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 7.300

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.esmoop.2022.100474

UT WoS

001044008800008

Keywords in English

checkpoint inhibitors; fatigue; meta-analysis; chemotherapy; immunotherapy; targeted therapy

Abstract

V originále

Background: Fatigue is one of the most common adverse effects associated with cancer immunotherapy using checkpoint inhibitors (CPIs). Because treatment-related fatigue also frequently occurs in patients treated with non-immunological therapies, our study aimed to compare the incidence of fatigue in CPI-treated patients with that associated with non-immune therapies in randomised trials. Methods: PubMed and ClinicalTrials.gov were searched for phase III studies using a CPI alone or in combination with chemotherapy or non-immunologic targeted therapy in the experimental arm and control arm using inactive therapies such as placebo or observation, chemotherapy, or non-immunologic targeted therapy. Adverse events listed in the full texts as well as those available from clinicaltrials.gov were reviewed for all identified studies. Results: A total of 60 studies involving 41 435 patients were included in the analysis. All-grade fatigue was reported in 30.4% of patients [95% confidence interval (CI) 29.9% to 31.0%] in the immunotherapy arms of the analysed studies. Using anti-programmed cell death protein 1 agents as reference, the odds ratio (OR) for fatigue was significantly higher both for anti-cytotoxic T lymphocyte-associated antigen 4 agents (OR 1.46, 95% CI 1.04-2.04) and the combination of anti-cytotoxic T lymphocyte-associated antigen 4 and anti-programmed cell death protein agents (OR 1.43, 95% CI 1.12-1.83). Fatigue was significantly less likely to occur in patients treated with CPI compared with patients receiving chemotherapy (OR 0.79, 95% CI 0.73-0.85), but significantly was more common in patients receiving the combination of CPI/chemotherapy compared with patients receiving chemotherapy alone (OR 1.12, 95% CI 1.03-1.22). Conclusions: Although immunotherapy using CPIs was associated with treatment-related fatigue, the occurrence of allgrade fatigue was significantly higher in patients treated with chemotherapy compared with patients receiving CPIs. The risk of fatigue was higher for CPI/chemotherapy combinations than for chemotherapy alone. These results suggest that although the effects of CPIs and chemotherapy are additive, chemotherapy was the dominant cause of treatment-related fatigue in the analysed trials.

Citovat

KISS, Igor, Matyáš KUHN, K. HRUSAK and T. BUCHLER. Incidence of fatigue associated with immune checkpoint inhibitors in patients with cancer: a meta-analysis. ESMO OPEN. AMSTERDAM: ELSEVIER, 2022, vol. 7, No 3, p. 1-7. ISSN 2059-7029. Available from: https://dx.doi.org/10.1016/j.esmoop.2022.100474.

@article{2417957,
   author = {Kiss, Igor and Kuhn, Matyáš and Hrusak, K. and Buchler, T.},
   article_location = {AMSTERDAM},
   article_number = {3},
   doi = {http://dx.doi.org/10.1016/j.esmoop.2022.100474},
   keywords = {checkpoint inhibitors; fatigue; meta-analysis; chemotherapy; immunotherapy; targeted therapy},
   language = {eng},
   issn = {2059-7029},
   journal = {ESMO OPEN},
   title = {Incidence of fatigue associated with immune checkpoint inhibitors in patients with cancer: a meta-analysis},
   url = {https://www.sciencedirect.com/science/article/pii/S2059702922000928?via%3Dihub},
   volume = {7},
   year = {2022}
}

TY  - JOUR
ID  - 2417957
AU  - Kiss, Igor - Kuhn, Matyáš - Hrusak, K. - Buchler, T.
PY  - 2022
TI  - Incidence of fatigue associated with immune checkpoint inhibitors in patients with cancer: a meta-analysis
JF  - ESMO OPEN
VL  - 7
IS  - 3
SP  - 1-7
EP  - 1-7
PB  - ELSEVIER
SN  - 20597029
KW  - checkpoint inhibitors
KW  - fatigue
KW  - meta-analysis
KW  - chemotherapy
KW  - immunotherapy
KW  - targeted therapy
UR  - https://www.sciencedirect.com/science/article/pii/S2059702922000928?via%3Dihub
N2  - Background: Fatigue is one of the most common adverse effects associated with cancer immunotherapy using checkpoint inhibitors (CPIs). Because treatment-related fatigue also frequently occurs in patients treated with non-immunological therapies, our study aimed to compare the incidence of fatigue in CPI-treated patients with that associated with non-immune therapies in randomised trials. Methods: PubMed and ClinicalTrials.gov were searched for phase III studies using a CPI alone or in combination with chemotherapy or non-immunologic targeted therapy in the experimental arm and control arm using inactive therapies such as placebo or observation, chemotherapy, or non-immunologic targeted therapy. Adverse events listed in the full texts as well as those available from clinicaltrials.gov were reviewed for all identified studies. Results: A total of 60 studies involving 41 435 patients were included in the analysis. All-grade fatigue was reported in 30.4% of patients [95% confidence interval (CI) 29.9% to 31.0%] in the immunotherapy arms of the analysed studies. Using anti-programmed cell death protein 1 agents as reference, the odds ratio (OR) for fatigue was significantly higher both for anti-cytotoxic T lymphocyte-associated antigen 4 agents (OR 1.46, 95% CI 1.04-2.04) and the combination of anti-cytotoxic T lymphocyte-associated antigen 4 and anti-programmed cell death protein agents (OR 1.43, 95% CI 1.12-1.83). Fatigue was significantly less likely to occur in patients treated with CPI compared with patients receiving chemotherapy (OR 0.79, 95% CI 0.73-0.85), but significantly was more common in patients receiving the combination of CPI/chemotherapy compared with patients receiving chemotherapy alone (OR 1.12, 95% CI 1.03-1.22). Conclusions: Although immunotherapy using CPIs was associated with treatment-related fatigue, the occurrence of allgrade fatigue was significantly higher in patients treated with chemotherapy compared with patients receiving CPIs. The risk of fatigue was higher for CPI/chemotherapy combinations than for chemotherapy alone. These results suggest that although the effects of CPIs and chemotherapy are additive, chemotherapy was the dominant cause of treatment-related fatigue in the analysed trials.
ER  -

KISS, Igor, Matyáš KUHN, K. HRUSAK and T. BUCHLER. Incidence of fatigue associated with immune checkpoint inhibitors in patients with cancer: a meta-analysis. \textit{ESMO OPEN}. AMSTERDAM: ELSEVIER, 2022, vol.~7, No~3, p.~1-7. ISSN~2059-7029. Available from: https://dx.doi.org/10.1016/j.esmoop.2022.100474.

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