1. Immunotherapy in advanced Non-Small Cell Lung Cancer patients with poor performance status: The role of clinical-pathological variables and inflammatory biomarkers
- Author
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Diego Signorelli, A. Prelaj, Benedetta Trevisan, Giacomo Massa, Giulia Galli, Marina Chiara Garassino, Carminia Maria Della Corte, Claudia Proto, Floriana Morgillo, Francesca Sparano, Giuseppe Lo Russo, Filippo de Braud, Raimondo Di Liello, Fortunato Ciardiello, Giuseppe Viscardi, Marta Brambilla, Maria Lucia Iacovino, Alessandro De Toma, Monica Ganzinelli, Roberto Ferrara, Riccardo Lobefaro, Lobefaro, R., Viscardi, G., Di Liello, R., Massa, G., Iacovino, M. L., Sparano, F., Della Corte, C. M., Ferrara, R., Signorelli, D., Proto, C., Prelaj, A., Galli, G., De Toma, A., Brambilla, M., Ganzinelli, M., Trevisan, B., Ciardiello, F., De Braud, F., Morgillo, F., Garassino, M. C., and Lo Russo, G.
- Subjects
0301 basic medicine ,Pulmonary and Respiratory Medicine ,Oncology ,Unfit ,Male ,Cancer Research ,medicine.medical_specialty ,Lung Neoplasms ,medicine.medical_treatment ,ECOG Performance Status ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Randomized controlled trial ,law ,Retrospective Studie ,Internal medicine ,Carcinoma, Non-Small-Cell Lung ,medicine ,Humans ,Progression-free survival ,Lung cancer ,Pathological ,Poor performance statu ,Poor performance status ,Retrospective Studies ,business.industry ,Immunotherapy ,Biomarker ,medicine.disease ,Non-Small Cell Lung Cancer ,030104 developmental biology ,030220 oncology & carcinogenesis ,Patient survival ,Female ,Non small cell ,Safety ,business ,Biomarkers ,Human - Abstract
Background: The introduction of immunotherapy has improved the prognosis of patients with Non-Small Cell Lung Cancer (NSCLC). However, data in poor ECOG Performance Status (PS) patients remain scant due to their exclusion from randomized trials. Material and methods: We analyzed data of patients with advanced NSCLC treated with immunotherapy in two Italian Centers, to evaluate the impact of PS (0-1 vs 2) on disease control rate (DCR), progression free survival (PFS) and overall survival (OS). Chi-square test was used to compare clinical-pathological variables, their impact on survival was evaluated through Cox proportional hazard models. Results: Among 404 patients included, PS was 0 in 137 (33.9 %), 1 in 208 (51.5 %) and 2 in 59 (14.6 %) patients; 143 were female and 90 had squamous NSCLC. Clinical-pathological variables were uniformly distributed except for higher prevalence of liver metastases in patients with poor PS. We found that PS2 patients showed worse outcomes in terms of DCR (21.8 % vs 50.3 %, p = 0.001), PFS [2.0 (95 % CI 1.6–3.0) vs 3.0 (95 % CI 2.7–4.0) months, p < 0.0001] and OS [4.0 (95 % CI 2.8–5.7) vs 13.2 (95 % CI 11.0−15.8) months, p < 0.0001]. PS2 status, negative PDL1 expression and early corticosteroids exposure as well as higher Neutrophil to Lymphocyte Ratio and LDH at baseline were associated with worse outcomes at univariate and multivariable analysis. Subgroup analysis confirmed poor outcomes in PS2 patients with high LDH and concomitant corticosteroid therapies. The incidence of Grade 3/4 adverse events was 11.3 % in PS 0−1 and 10.2 % in PS 2 patients (p = 0.81). Conclusion: Our data confirm reduced efficacy of immunotherapy in patients with poor PS even though a good safety. Despite PS remains the most powerful independent prognostic factor for NSCLC, LDH levels and steroids exposure could support the decision making in PS2 patients.
- Published
- 2020