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Thomas Lycan
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P2.04 - Immuno-oncology (ID 167)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.04-93 - Performance Status and Age as Predictors of Immunotherapy Outcomes in Advanced Non-Small Cell Lung Cancer (ID 2666)
10:15 - 18:15 | Author(s): Thomas Lycan
- Abstract
Background
Immunotherapy has become a standard of care treatment for patients with advanced non-small cell lung cancer (NSCLC). While a survival advantage has been proven for patients who are medically fit, it is unknown whether a benefit exists for patients with poor performance status (PS). PS has been established as one of the most powerful independent prognostic factors in advanced NSCLC since it is a strong predictor of survival and adverse events. When treated with conventional chemotherapy, patients with poor PS have worse outcomes and higher rates of toxicity which is why they have been excluded from many clinical trials. Standard treatment is generally recommended in patients with PS 0-1, while best supportive care is offered to patients with PS 4. Clinical trials are needed to define the best practices for patients with PS 2 and PS 3.
Method
We performed a retrospective analysis of NSCLC patients who received immunotherapy in our health system. Patients were identified using drug administration and diagnosis codes. Age and PS at the time of initial immunotherapy administration were assigned based on physician documentation. Radiographic response and date of progression were initially assigned according to the treating physician’s assessment and confirmed by the study team. Immune related adverse events (irAE) were extracted from records. All steroid prescriptions and hospitalizations were independently reviewed and attributions assigned.
Result
We identified 285 NSCLC patients who received immunotherapy between January 2014 and April 2018. In this group, 153 patients (53.7%) had PS 0-1, 114 (40.0%) had PS 2, and 18 (6.3%) had PS 3. Response rates were similar across PS groups with responses in 26.6% for PS 1, 25.2% for PS 2, and 23.1% for PS 3 (p=.95). Survival outcomes varied with pre-treatment PS. For PS 0-1, PS 2, and PS 3, median overall survivals (OS) were 14.7 months, 8.3 months, and 1.5 months (p<0.001), and progression-free survivals (PFS) were 7.4 months, 5.1 months, and 1.3 months (p<0.001). OS and PFS outcomes were not significantly different for older and younger patients. Patients less than 70 years had a lower rate (7.6%) of irAE requiring steroids compared to patients over 70 (15%) (p=0.04). Patients less than 70 had a higher mean number of ICU admissions (p=0.04) and total days in the ICU (p=0.007) compared to patients over 70.
Conclusion
Patients with poor baseline PS demonstrate similar response rates but inferior PFS and OS compared to medically fit patients. Prospective trials are needed to optimize treatment for this large population. Differences in irAE management and irAE severity according to age warrant further investigation.
