Quality matters: immunotherapy and the evolving landscape of advanced cancer care

ABSTRACT Introduction: Immunotherapy has been FDA approved in several first line and many more second line settings in patients with advanced cancer. While only a subset of patients derive benefit from checkpoint blockade, the potential for durable responses and tolerable adverse effects make it an appealing option. Patient quality of life on the therapy is a particularly important consideration given its therapeutic intent is non-curative. Areas covered: The primary focus of this review is exploring studies which led to the approval of checkpoint inhibitors in a variety of tumor types, with a specific emphasis on studies looking at patient related outcomes (PRO). The latter part of the review focuses on identification and management of unique immune related toxicities. Expert commentary: PROs are improved with immunotherapy compared to chemotherapy largely by reducing functional decline and impacting global health less negatively in patients. There remain numerous questions about checkpoint inhibitors including what is the optimal duration of treatment, will they be tolerable when combined with immune stimulatory agonists or chemotherapy, and how do we increase the number of patients who derive benefit from them. We are only beginning to scratch the surface of their potential.