When survival improves but quality of life does not: a model-based meta-analysis of immune checkpoint inhibitors

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ID: 320735
2026
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Abstract
Abstract Background In immune checkpoint inhibitor (ICI) trials, overall survival (OS) benefits are well established, yet improvements in quality of life (QoL) are often inconsistent or absent in conventional analyses. This apparent discordance raises important questions: are QoL outcomes truly unrelated to survival, and how can QoL results be better utilized and interpreted? Methods A model-based meta-analysis (MBMA) of longitudinal EORTC QLQ-C30 global health status/quality of life data from ICI clinical trials was conducted. Longitudinal QoL trajectories were analyzed using a nonlinear mixed-effects model to estimate treatment-related toxicity and long-term QoL improvement. Associations between QoL trajectory parameters and OS were assessed using spearman rank correlation tests and Cox proportional hazards models. Results Twenty-seven studies (8,149 ICI and 5,593 control patients) contributed longitudinal QoL data, and 18 studies provided matched OS data. Raw QoL trajectories showed overlap between treatment arms, while OS consistently favored ICIs. MBMA revealed that ICIs had similar toxicity but significantly faster QoL improvement than control therapies (p < 0.0001). Baseline QoL, toxicity, and QoL improvement rate were all significantly associated with OS (p < 0.001). MBMA-based QoL comparisons were more sensitive in detecting associations with survival than raw QoL data, with the strongest association observed at Week 24 (R = -0.37, p = 0.067). Conclusions Conventional analyses comparing QoL at a single time point may obscure meaningful patient-reported benefits. By capturing longitudinal QoL trajectories across trials, MBMA reveals how patient experience evolves alongside survival outcomes and supports improved interpretation and utilization of QoL data in treatment evaluation.
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openalex_W7168028638 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Yimeng Sun, Shiwon Chang, Kayden Tang, Matthew Roger LeBlanc, Adam C Palmer, Malidi Ahamadi, Jiawei Zhou
Journal JNCI Journal of the National Cancer Institute
Year 2026
DOI
10.1093/jnci/djag228
URL
https://doi.org/10.1093/jnci/djag228
Keywords Keywords not found

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