How Do Immune Checkpoint Inhibitors Affect Quality of Life in Real-World Patients With NSCLC?

Real-world patients with non-small cell lung cancer (NSCLC) who were treated with immune checkpoint inhibition experienced improved long-term quality of life (QOL), according to results from a recent study.

A team of researchers from Denmark conducted the study to explore the effect of immune checkpoint inhibition on NSCLC among real-world patients versus patients from randomized controlled trials. They presented their findings in a poster display session during the 2025 European Lung Cancer Congress (ELCC).

The investigators evaluated quality of life in patients with advanced NSCLC who received palliative immune checkpoint inhibition treatment from 2018 to 2021. The European QOL 5 Dimensions-5 level and EORTC QOL Questionnaire Core 30 were used to assess quality of life at the initiation of treatment, as well as at 9, 18, 26, 52, and 104 weeks during treatment.

Furthermore, the researchers documented immune-related adverse events and analyzed quality of life data using linear mixed models. They conducted subgroup analyses on age, comorbidities, line of treatment, performance status, polypharmacy, brain metastases, and reasons patients discontinued treatment. During the first 18 weeks of treatment, Kaplan-Meier estimates were used to compare survival among the subgroups with improved general health status versus those with impaired general health status.

The total cohort included 166 patients with a mean age of 68 years. The results showed that patient quality of life “significantly improved at all visits compared to baseline.” Line of treatment and an age greater than 70 years did not affect quality of life, but performance status and polypharmacy did.

Among immune-related adverse events, the results revealed that nausea, vomiting, and insomnia improved by week 9, while fatigue and appetite loss improved by week 18. According to the findings, patients who completed 2 years of immune checkpoint inhibition treatment had higher quality of life baseline scores than patients who discontinued treatment due to immune-related adverse events (P=0.01/0.0002).

For general health status, the researchers found that the baseline score among both groups was “similar,” however general health status “improved significantly during initial weeks of [immune checkpoint inhibition] in those completing two years.” In addition, reduced survival was associated with impaired general health status during the initial 18 weeks of treatment.

The study showed that symptom relief and improved quality of life were benefits of immune checkpoint inhibition experienced by patients with advanced NSCLC. Higher quality of life scores at treatment baseline were correlated with an increased likelihood of completing the full treatment course, while “early impairment” of general health status within 18 weeks of treatment was associated with decreased long-term survival.

“Thus, [quality of life] is an important clinical tool to predict long-term outcome[s] in [real-world] patients,” the investigators concluded.

Reference

European Lung Cancer Congress 2025. Abstract 107P. https://www.jto.org/article/S1556-0864(25)00302-8/fulltext