Translational Evaluation of Combined Immunotherapeutic Strategies and Advanced Supportive Care in Reducing Treatment-Related Toxicities Among Patients with Solid Malignancies

• Agussalim Agussalim

  Parepare School of Nursing, Makassar Health Polytechnic, Ministry of Health Republic of Indonesia, South Sulawesi, Indonesia

Background: Immune checkpoint inhibitors and combination immunotherapeutic regimens have substantially improved survival outcomes across advanced solid malignancies. However, treatment-related toxicities—particularly immune-related adverse events (irAEs)—frequently compromise therapeutic continuity, adherence, quality of life, and clinical benefit.

Objective: This translational investigation evaluates whether integrating immunotherapy with a structured, multidisciplinary advanced supportive care framework reduces treatment-associated toxicities.

Methods: A prospective multicenter longitudinal cohort study was conducted across accredited Type B hospitals in Indonesia, enrolling 500 patients with histologically confirmed advanced solid malignancies receiving PD-1/PD-L1-based immunotherapy or chemo-immunotherapy. All participants received standardized early toxicity surveillance, personalized nutritional optimization, and structured psychosocial support. Toxicity was graded using CTCAE v5.0. Outcomes were compared against institutionally established historical benchmarks derived from 412 comparable patients treated at participating centers during 2021–2022 prior to protocol implementation. Analytical approaches included mixed-effects regression, Kaplan–Meier estimation, multivariate logistic regression, and effect-size estimation with 95% confidence intervals.

Results: Severe (grade ≥3) treatment-related toxicity occurred in 18.0% of patients, representing a 30.8% relative reduction from the historical benchmark of 26.0% (risk difference −8.0%, 95% CI −12.1% to −3.9%, p<0.001). Hospitalization rate was 22.0% (27.9% relative reduction from benchmark, p<0.001). Treatment adherence (≥85% planned cycles completed) was 85.6% versus 72.3% historically (p<0.001). Early toxicity monitoring (β = −0.41, 95% CI −0.58 to −0.24, p<0.001), nutritional optimization (β = −0.36, 95% CI −0.52 to −0.20, p<0.001), and psychosocial support (β = −0.29, 95% CI −0.45 to −0.10, p = 0.003) were independent protective predictors.

Conclusion: Integrated proactive supportive care significantly ameliorates toxicity burden and improves tolerability. Systematic implementation alongside immunotherapy is recommended to optimize outcomes in routine oncology practice.

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