ICIs for advanced NSCLC: check performance status first

  • Petrillo LA & al.
  • Cancer
  • 6 Mar 2020

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Patients with NSCLC who have poor performance status (PS) when they initiate immune checkpoint inhibitors (ICIs) have significantly worse outcomes than those with better PS.

Why this matters

  • These findings suggest that clinical trials, which have largely excluded patients with poor PS, may not be generalizable to all patients.
  • They also suggest that clinicians should consider whether to recommend ICI treatment for advanced NSCLC with poor PS.

Study design

  • 237 patients with NSCLC received ICIs.
  • Median follow-up, 37 months.
  • Funding not disclosed.

Key results

  • 35.4% had poor PS (Eastern Cooperative Oncology Group PS ≥2).
  • Median ICI treatment was significantly shorter in patients with poor PS compared with those with PS 0 or 1:
    • 37 days vs 119 days (P<.0001>
  • Compared with patients with PS ≥2, those with PS 0 or 1 had significantly better median:
    • PFS: 3.4 vs 1.7 months (P<.0001>
    • OS: 14.3 vs 4.5 months (P<.0001>
  • PS ≥2 significantly increased mortality risk:
    • Adjusted HR, 2.37 (95% CI, 1.71-3.30).
  • Patients with PS ≥2 were more likely to be hospitalized within 30 days of death: 
    • 58.3% vs 40.7% (P=.021).

Limitations

  • Single-center, retrospective study.