ECOG performance status ≥2 as a prognostic factor in patients with advanced non small cell lung cancer treated with immune checkpoint inhibitors—A systematic review and meta-analysis of real world data

Dall’Olio, Filippo Gustavo; Maggio, Ilaria; Massucci, Maria; Mollica, Veronica; Fragomeno, Benedetta; Ardizzoni, Andrea

doi:10.1016/j.lungcan.2020.04.027

Cited by 110 publications

(93 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, a meta-analysis of 19 studies that explored the prognostic impact of PS ≥2 on survival in patients NSCLC who received ICIs suggested that PS at the start of ICI treatment had prognostic significance, but the predictive value of PS 2 regarding the response to ICIs remained unclear. 22 These previous reports and the present study suggested that ICI treatment should not be recommended for patients with NSCLC and poor PS, but can we conclude that these patients are truly ineligible for ICI therapy? The results of our prior survival analyses indicated that PD-L1 expression in tumor specimens could be one of the keys for optimizing therapeutic intervention in populations with poor survival.…”

Section: Dovepressmentioning

confidence: 48%

Anti–PD-1 Monotherapy for Advanced NSCLC Patients with Older Age or Those with Poor Performance Status

Matsubara¹,

Seto²,

Takamori³

et al. 2021

OTT

View full text Add to dashboard Cite

Anti-programmed death 1 (PD-1) antibodies have emerged as frontline treatments for patients with advanced non-small cell lung cancer (NSCLC) on the basis of global Phase III trials. However, current data regarding responses to anti-PD-1 therapy in older patients with NSCLC or those with poor performance status (PS) are limited. Therefore, we examined the therapeutic effect of anti PD-1 antibody in these patients. Patients: We retrospectively examined consecutive patients treated with anti-PD-1 monotherapy (pembrolizumab or nivolumab) from January 2016 to September 2018. Results: We enrolled 125 patients (median age, 60 years), 80.8% of whom were men. Patients aged ≥75 years were considered older patients (n = 15), and those with PS 2-3 were regarded as having poor PS (n = 11). The objective response and disease control rates were 15.4% and 46.2%, respectively, in older patients and 9.1% and 27.3%, respectively, in those with poor PS. Progression-free survival (PFS) and overall survival (OS) did not significantly differ between older and younger patients. However, poor PS was significantly associated with poor survival. High programmed death ligand 1 (PD-L1) expression in tumor specimens (≥50%) was associated with favorable survival in the entire cohort as well as patients with poor PS. Safety analyses demonstrated no significant difference in the occurrence of any adverse event, including grade ≥3 adverse events, between patients with poor PS or older age and the remaining patients. Conclusion: Anti-PD-1 therapy had similar efficacy in older and younger patients with NSCLC, whereas survival was significantly worse in patients with poor PS. However, immune checkpoint inhibitors may be considered for patients with poor PS harboring positive PD-L1 expression.

show abstract

Section: Dovepressmentioning

confidence: 48%

Anti–PD-1 Monotherapy for Advanced NSCLC Patients with Older Age or Those with Poor Performance Status

Matsubara¹,

Seto²,

Takamori³

et al. 2021

OTT

View full text Add to dashboard Cite

show abstract

“…Furthermore, a reduced PS could be an indicator of aggressive tumor biology with intrinsic resistance to ICI therapy. In a meta-analysis of real world NSCLC data including 19 studies it could be shown that PS ≥2 is a poor prognostic factor in terms of RR, PFS and OS for patients treated with ICI [30]. The authors stated that ECOG PS ≥2 patients constitute an inhomogeneous group of patients where the poor clinical condition might be linked with comorbidities, cancer or both.…”

Section: Eastern Cooperative Oncology Group Performance Status (Ecog-ps)mentioning

confidence: 99%

Clinically relevant prognostic and predictive markers for immune-checkpoint-inhibitor (ICI) therapy in non-small cell lung cancer (NSCLC)

2020

View full text Add to dashboard Cite

Background Immune checkpoint inhibitors (ICI) either alone or in combination with chemotherapy have expanded our choice of agents for the palliative treatment of non-small cell lung cancer (NSCLC) patients. Unfortunately, not all patients will experience favorable response to treatment with ICI and may even suffer from severe side effects. Therefore, prognostic and predictive markers, beyond programmed death ligand 1 (PD-L1) expression status, are of utmost importance for decision making in the palliative treatment. This review focuses on clinical, laboratory and genetic markers, most of them easily to obtain in the daily clinical practice. Results Recently, a number of prognostic and predictive factors in association to palliative ICI therapy have been described in NSCLC. Besides biometric parameters and clinical characteristics of the tumor, there are useful markers from routine blood sampling as well as innovative soluble genetic markers which can be determined before and during ICI treatment. Additionally, the level of evidence is noted. Conclusions These factors can be helpful to predict patients’ outcome and tumor response to ICI. They should be implemented prospectively in ICI based clinical trials to develop reliable algorithms for palliative NSCLC treatment.

show abstract

“…Immunotherapy based on immune checkpoint inhibitors represents one of the most important breakthroughs in the management of solid tumors, including lung cancers with promising results in numerous clinical trials. 5 Programmed death-ligand 1 (PD-L1) expression is consistently associated with clinical efficacy in anti-PD-1/PD-L1 treatment. [6][7][8] The US Food and Drug Administration approved PD-L1 22C3 and 28-8 clones as a companion diagnostic for pembrolizumab and as a complementary diagnostic method for nivolumab, respectively, in 2015.…”

Section: Introductionmentioning

confidence: 99%

<p>High PD-L1 Expression is Associated with Unfavorable Clinical Outcome in <em>EGFR</em>-Mutated Lung Adenocarcinomas Treated with Targeted Therapy</p>

Yoon

Chang

Lee

2020

OTT

View full text Add to dashboard Cite

Purpose: Although programmed death-ligand 1 (PD-L1) expression is widely accepted as a predictive and prognostic biomarker in immunotherapy, its implications in lung cancer patients with driving mutations are still unclear. The objective of this study is to determine the association between PD-L1 expression and treatment outcome in epidermal growth factor receptor (EGFR)-mutated lung cancer treated with tyrosine kinase inhibitors (TKIs). Methods: We retrospectively enrolled EGFR-mutant, advanced lung adenocarcinoma patients who received first-line EGFR-TKIs and evaluated the PD-L1 tumor proportion score (TPS) using the 22C3 pharmDx assay. We investigated the distribution of patients with different PD-L1 TPS values, followed by the analysis of response rate (RR), survival rate, and incidence of secondary T790M mutation according to the PD-L1 TPS group. Results: Among the 131 patients analyzed, the proportion of patients with PD-L1 TPS ≥ 50%, 1-49%, and <1%, was 17.6%, 32.8%, and 49.6%, respectively. The RR was significantly lower in the group with PD-L1 TPS ≥ 50% than in the other groups (43.5% vs 72.1% vs 78.5%, all p = 0.001). In multivariate analysis, PD-L1 TPS ≥ 50% was independently associated with a significantly shorter PFS in the overall population (hazard ratio [HR] = 2.64, p = 0.004) and associated with shorter OS in patients with exon 19 deletion (HR = 2.55, p = 0.041) compared with PD-L1 TPS < 50%. In addition, the frequency of secondary T790M mutation after TKI failure was significantly lower in the group with PD-L1 TPS ≥ 50% than in the other groups (13.3% vs 40.0% vs 53.3%, all p = 0.001). PD-L1 TPS ≥ 50% was an independent predictor of a lower frequency of this mutation (HR = 0.63, p = 0.043). Conclusion: High PD-L1 expression was associated with unfavorable clinical outcome and less development of secondary T790M mutation, suggesting a distinct subgroup warranting active surveillance and tailored therapeutic approach.

show abstract

ECOG performance status ≥2 as a prognostic factor in patients with advanced non small cell lung cancer treated with immune checkpoint inhibitors—A systematic review and meta-analysis of real world data

Cited by 110 publications

References 34 publications

Anti–PD-1 Monotherapy for Advanced NSCLC Patients with Older Age or Those with Poor Performance Status

Anti–PD-1 Monotherapy for Advanced NSCLC Patients with Older Age or Those with Poor Performance Status

Clinically relevant prognostic and predictive markers for immune-checkpoint-inhibitor (ICI) therapy in non-small cell lung cancer (NSCLC)

<p>High PD-L1 Expression is Associated with Unfavorable Clinical Outcome in <em>EGFR</em>-Mutated Lung Adenocarcinomas Treated with Targeted Therapy</p>

Contact Info

Product

Resources

About