The benefit of treatment beyond progression with immune checkpoint inhibitors: A multi- center study

Objective: Treatment beyond progression (TBP) with immune checkpoint inhibitors (ICIs) is an evolving field due to the limitations of conventional imaging in response evaluation with ICIs. However, real-life data on the benefit of TBP is scarce, especially from the limited resource settings. Therefore, we aimed to investigate the survival benefit of TBP with ICIs in patients with advanced tumors from a limited resource setting. Methods: : For this multicenter study, we included 282 patients treated with ICIs and radiological progression according to RECIST 1.1 criteria. The evaluated post-progression survival according to the use of TBP (TBP and non-TBP groups) with univariate and multivariate analyses. Results: : 82 (29.1%) of 282 patients continued on ICIs following the initial progression event. In multivariate analyses, patients in the TBP group had improved post-progression survival compared to non-TBP (13.18 vs. 4.63 months, HR: 0.500, 95% CI: 0.349-0.717, p<0.001). The benefit of the TBP was independent of the tumor type, treatment line, and patient age. Furthermore, TBP with ICIs was associated with improved post-progression survival (HR: 0.600, 95% CI: 0.380-0.947, p=0.028) in the additional analyses after excluding the patients with no further treatment after progression in the non-TBP arm. Conclusions: : In this study, we observed that patients receiving ICIs beyond progression had considerably longer survival. Continuation of ICIs after progression should be kept in mind as a reasonable management option for patients with advanced cancer, specifically for patients with limited alternative options.