Immunotherapy "stop and go" and early discontinuation: A viable option in limited resources setting

BackgroundImmunotherapy (IO) has transformed cancer treatment, improving survival across various malignancies. However, optimal treatment duration and dosing regimens remain unclear. In low- and middle-income countries like Tunisia, access to IO is hindered by financial and logistical constraints, often leading to treatment interruptions. Understanding the impact of these interruptions on patient outcomes is crucial for optimizing care in resource-limited settings.This study aimed to evaluate the clinical outcomes of cancer patients who experienced IO interruptions in Tunisia due to factors unrelated to disease progression or limiting toxicity. It explored the feasibility of "stop and go" and early discontinuation strategies as potential alternatives in such settings.MethodsThis retrospective study included 82 cancer patients who experienced IO interruptions for reasons other than disease progression or limiting toxicity between 2019-2023. Interruptions were defined as delays beyond the standard inter-cycle interval which is usually 21 dyas (Stop and go) or therapy cessation before the recommended 2-year duration. Data were collected from hospital records, and the study evaluated response, overall survival (OS) and time to progression (TTP) using the Kaplan-Meier method.ResultsThe study population consisted mostly of males (79%) with non-small cell lung cancer (NSCLC) in 67%. Treatment interruptions occurred in two patterns: early discontinuation (43.8%) and on-off schedules (56.3%). The main cause of interruption was drug unavailability (66%). The response to IO included 2.7% complete response and 38.4% partial response. Median OS was 31 months and median TTP was 7.72 months. Univariate analysis did not reveal any significant prognostic factors.ConclusionsIO interruptions, though often unavoidable in resource-constrained settings, can yield outcomes comparable to uninterrupted therapy when managed effectively. Optimizing dosing regimens and personalizing treatment strategies may enhance access and efficacy while reducing costs and toxicity. These findings support the feasibility of alternative IO approaches in limited-resource settings for selected patients.