Analyzing fatigue as a common adverse effect in patients treated with immune checkpoint inhibitors.

Abstract

e23190 Background: The discovery of Immune checkpoint inhibitors has been a big step in oncology due to its role in the disruption of immune pathways by which tumor cells invade the immune system. However, there are various patient-reported adverse effects related to this group of medications. Fatigue has been one of the most common and hardest-to-treat adverse effects experienced by this patient population. Studies have shown that the incidence of fatigue is seen in 16-37% of patients treated with anti-PD-1 agents and 12-24% of patients treated with anti-PD-L1 agents. The mechanism of fatigue in this patient population remains unclear however there have been theories on how immunotherapies can interfere by modulating the signaling process in the central nervous system. This study focuses on identifying the incidence of fatigue as an adverse effect in patients treated with anti-PD-1 and anti-PD-L1 agents. Methods: This is a single-center, retrospective, and observational study that investigated patients treated with anti-PD1 and anti-PDL1 agents for the management of any type of cancer between January 2022 and September 2023. Data of patients treated during this period was obtained, and a retrospective chart review was performed to identify the most common adverse effects experienced by individual patients in our study population. The primary outcome was to determine the number of patients who experienced fatigue as a primary adverse effect after treatment with anti-PD1 and anti-PD-L1. The secondary outcomes were to determine other factors which could have contributed to the patient-reported adverse effect of fatigue including concomitant treatments and coexisting medical conditions. Results: The data consisted of 93 patients of which 28 out of 92 (30.4%) patients reported fatigue as the most common adverse event. Among the patients with fatigue, Ipilimumab use was seen in 4 (14.2%) patients and concomitant chemotherapy was used in 14 (50%) patients. In this subgroup of patients with fatigue, 14 (50%) had anemia, 3 out of 21(14.2%) had hypothyroidism, 5 out of 28 (17.8%) were screened for adrenal insufficiency (AI) and none had AI. Anti-PD1 and Anti-PD-L1 associated fatigue was observed in 13 (46.4%) patients. Conclusions: Though the main goal in anticancer treatments remains to prolong survival, Patient-reported adverse effects like fatigue can severely impact the quality of life in these patients, and studies to better understand their mechanism might help improve symptomatic treatment strategies in these patients.