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Impact of Performance Status on Outcomes Among Patients Receiving ICIs for Advanced Tumors
Findings from a recent study suggest avoiding the use of immune checkpoint inhibitors (ICIs) in patients with advanced malignancy and poor performance status, as the outcomes are poor in this group (JCO Oncol Pract. 2021; OP2001055. doi:10.1200/OP.20.01055).
ICIs have previously been approved through clinical trials, however, those trials almost exclusively consisted of patients with good Eastern Cooperative Oncology Group performance status (ECOG PS of 0 to 1).
This retrospective study aimed to understand how ICIs perform in patients with advanced tumors and poor PS. “We hypothesized that patients with an ECOG PS of 2 or higher would have worse outcomes with ICI,” wrote Mridula Krishan, MD, Division of Hematology Oncology, University of Nebraska Medical Center, Omaha, NE, and colleagues.
Data from patients with advanced solid tumors who were treated with ICIs at the University of Nebraska Medical Center were used for this study. Authors compared survival among patients with various ECOG PS, and then constructed a proportional hazards model to investigate associations between ECOG PS and overall survival (OS) with adjustment for covariates like age, sex, malignancy type, time from advance disease diagnosis, and line of therapy.
Among the 257 patients who were treatment with ICIs, 182 had an ECOG PS of 0 to 1, and 75 had an ECOG PS 2 or higher. The group of patients with an ECOG PS of 0 to 1 had a median overall survival of 12.6 months, while the group of patients with an ECOG PS of 2 or higher had a median overall survival of 3.1 months.
Patients with an ECOG PS of 0 to 1 had an overall response rate of 23%, while those with poor PS were at 8% (P = .005).
Among the patients with an ECOG PS of 2 or higher, the rate for hospice referrals was 67%, and those in this group were 28.6% likely to have an in-hospital death. Among the patients with an ECOG PS of 0 to 1, the rate for hospice referrals was 61.9%, and the likelihood of an in-hospital death was 15.1%.
“Despite the appeal of ICI in patients with advanced malignancy and poor PS, outcomes in this cohort were poor,” concluded Dr Krishan and colleagues, adding, “Prospective trials defining the activity and role of ICI in poor PS are urgently needed.”—Marta Rybczynski
