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Clin Oncol (R Coll Radiol). 2016 Oct;28(10):e127-38. doi: 10.1016/j.clon.2016.06.008. Epub 2016 Jun 20.

Treatment-associated Fatigue in Cancer Patients Treated with Immune Checkpoint Inhibitors; a Systematic Review and Meta-analysis.

Author information

1
Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; OncoCentrum Zurich, Gastrointestinal Tumor Center Zurich (GITZ), Zurich, Switzerland. Electronic address: omar.abdelrhman@med.asu.edu.eg.
2
OncoCentrum Zurich, Gastrointestinal Tumor Center Zurich (GITZ), Zurich, Switzerland.
3
Surgical Center Zurich - Hirslanden Hospital Zurich, Switzerland.
4
OncoCentrum Zurich, Swiss Tumor Immunology Institute (SwissTII), Zurich, Switzerland.
5
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
6
Department of Oncology, Center of Zug, Switzerland.
7
Department of HPB and Liver Transplantation, Rajhy Liver Hospital, Assiut University, Assiut, Egypt.
8
Surgical Center Zurich - Hirslanden Hospital Zurich, Switzerland; Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.

Abstract

AIMS:

Fatigue is one of the most prominent side-effects of immune checkpoint inhibition. Therefore, we assessed the risk of fatigue associated with inhibitors of the immune checkpoints.

MATERIALS AND METHODS:

We examined data from the Medline and Google Scholar databases. We also examined original studies and review articles for cross-references. Eligible studies included randomised phase II and phase III trials of patients with cancer treated with ipilimumab, nivolumab, pembrolizumab and tremelimumab. The authors extracted relevant information on participants(') characteristics, all-grade and high-grade fatigue and information on the methodology of the studies.

RESULTS:

In total, 17 trials were considered eligible for the meta-analysis. The odds ratio for all-grade fatigue for CTLA-4 inhibitors was 1.23 (95% confidence interval 1.07, 1.41; P = 0.003) and for high-grade fatigue was 1.72 (95% confidence interval 1.26, 2.33; P = 0.0005). Moreover, the odds ratio for all-grade fatigue for PD-1 inhibitors was 0.72 (95% confidence interval 0.62, 0.84; P < 0.0001) and for high-grade fatigue was 0.36 (95% confidence interval 0.23, 0.56; P < 0.00001).

CONCLUSIONS:

The analysis of data showed that CTLA-4 inhibitors seem to be associated with a higher risk of all- and high-grade fatigue compared with control regimens, whereas PD-1 inhibitors seem to be associated with a lower risk of all- and high-grade fatigue compared with control regimens.

KEYWORDS:

Fatigue; ipilimumab; nivolumab; pembrolizumab; tremelimumab

PMID:
27339403
DOI:
10.1016/j.clon.2016.06.008
[Indexed for MEDLINE]

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