Assessment of the utilization of immunotherapy in Sub-Saharan Africa.

Abstract

e18578 Background: The Lancet Oncology Commission for sub-Saharan Africa predicts that cancer deaths will double from 520,158 per year to more than 1 million by the year 2030. These striking figures indicate a need to urgently evaluate cancer treatment infrastructure and resources in the region. Studies have found immunotherapy to be effective for the treatment of advanced-stage cancer, which almost 70% of patients in SSA present with. Despite immunotherapy’s significant curative potential, its utilization in SSA is not well documented. The purpose of this study was to evaluate the landscape of immunotherapy in SSA. Methods: A Qualtrics survey assessing the utilization and existing infrastructure and training for safe immunotherapy administration was developed and distributed online to SSA oncology networks including that of the HypoAfrica clinical trial. The target population for the survey was healthcare providers in SSA serving patients with cancer. Descriptive statistics methods were used to analyze the data. Results: 288 responses were collected from 29 countries in SSA. Clinical and medical oncologists made up 23% of respondents and nurses made up 24%. 45% of respondents were familiar with immunotherapy. 11% indicated they were adequately trained to administer it. Of these (n = 32), 53% indicated also being trained to manage immune related adverse events related to immunotherapy administration. 29% of all survey respondents indicated that their clinic has easy access to cancer immunotherapy and 45% indicated that their clinic currently practices immunotherapy. Of clinics that practiced immunotherapy (n = 129), 12% used genomic sequencing to assess tumor mutational burden, and 43% assessed patient expression of pathologic biomarker PD-L1 prior to administration. The most common types of immunotherapies used were monoclonal antibodies (44%) and checkpoint inhibitors (17%). Conclusions: Less than half of surveyed clinics currently utilize immunotherapy, and even fewer employ biologic tools to predict immunotherapy response prior to administration, which threatens the safety and efficacy of its use. Additional training for management of immunotherapy-related adverse effects is needed. Laboratory techniques to identify patients best suited for immunotherapy, and incorporation of immunotherapy training into continuous medical education may be prerequisites for wider, effective adoption of this technique in SSA.