Survey Illustrates Current Status of PD-1/PD-L1 Inhibitors in China

Researchers indicated that a lack of understanding of the mechanism and efficacy of PD-1/PD-L1 inhibitors is the major barrier for prescription of these inhibitors in Chinese tumor treatment-related departments.

A survey study published in BMC Cancer highlighted the current status of PD-1/PD-L1 inhibitors in China in order to enact more purposeful doctor re-education. 

In conducting this research, the authors found that not understanding the mechanism and efficacy is the major barrier for prescription of PD-1/PD-L1 inhibitors in Chinese tumor treatment-related departments.

Other concerning issues that appeared were the extensive use of PD-1/PD-L1 inhibitors in off-label situations and prescribers not having participated in any previous research to qualify them to judge the efficacy of an immune checkpoint inhibitor. 

“Chinese doctors generally lack a basic knowledge of immunotherapy, and there are phenomena such as abuse, contraindications, and use of off-label medications in clinical practice,” the authors wrote. “Therefore, investigating the current status of immunotherapy in cancer-related medical departments in China is useful.” 

The questionnaire was administered online and offline to cancer-related medical departments in 30 different provinces and autonomous regions of China. The survey consisted of three sections including general information, current status of the application of PD-1/PD-L1 inhibitors in the clinic, and oncologists’ concerns regarding utilization. The valid response rate of the survey was 76.3% and, proportionately, participation among senior doctors (physician-in-charge or a more superior position for more than 3 years) was relatively high (67% in 588). 

Of the respondents, 59.2% had prescribed PD-1/PD-L1 inhibitors during clinical treatment, and the most frequent reason for not prescribing these inhibitors was the answer choice “do not understand the mechanism and the efficacy of PD-1/PD-L1 inhibitors.” Additionally, 77.9% of the prescribers indicated that they used the medications in an off-label situation, and the most significant reason for this was the fact that “there were indications abroad but not domestically.” Moreover, 77.9% of the prescribers held the belief that “immunotherapy-related adverse effects could not be controlled or intervened through follow-up management.” 

Above all, prescribers expressed that they were most concerned about “how to identify pseudo-progression and hyper-progression” and “immunity-related adverse effects management.”

To overcome this lack of comprehension, researchers indicated that the relevant state department should create an effective permission regulation system for conducting immunotherapy and implement specific training and re-education for doctors. 

“Pharmaceutical companies should increase their investment in clinical trials of immunotherapy and in the promotion of this work to civilians,” the researchers elaborated. “Additionally, clinicians should consciously take steps to study the progress of theoretical and clinical research to further standardize their clinical operation regarding immunotherapy.”

Notably, the authors also suggested that the Chinese Society of Clinical Oncology Immuno-Oncology (CSCO IO) play a more prevalent role in helping Chinese physicians in this area by organizing city tours, publishing guidelines, holding national conferences, and maintaining cooperation with international organizations such as the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO). 

The most substantial limitation of this survey was that only doctor groups were surveyed, therefore the patient point of view in regard to immunotherapy is lacking. Researchers indicated that CSCO IO should implement future plans to illustrate the status of cancer immunotherapy in patient groups. 


Zhang B, Song Y, Fu Y, Zhu B, Wang B, Wang J. Current status of the clinical use of PD-1/PD-L1 inhibitors: a questionnaire survey of oncologists in China. BMC Cancer. doi:10.1186/s12885-020-6583-3.