Cancers (Mar 2021)

Does Very Poor Performance Status Systematically Preclude Single Agent Anti-PD-1 Immunotherapy? A Multicenter Study of 35 Consecutive Patients

  • Valérie Gounant,
  • Michael Duruisseaux,
  • Ghassen Soussi,
  • Sylvie Van Hulst,
  • Olivier Bylicki,
  • Jacques Cadranel,
  • Marie Wislez,
  • Jean Trédaniel,
  • Jean-Philippe Spano,
  • Carole Helissey,
  • Christos Chouaid,
  • Olivier Molinier,
  • Xavier Dhalluin,
  • Ludovic Doucet,
  • José Hureaux,
  • Aurélie Cazes,
  • Gérard Zalcman

DOI
https://doi.org/10.3390/cancers13051040
Journal volume & issue
Vol. 13, no. 5
p. 1040

Abstract

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Anti-PD-1 antibodies prolong survival of performance status (PS) 0–1 advanced non-small-cell lung cancer (aNSCLC) patients. Their efficacy in PS 3–4 patients is unknown. Conse- cutive PS 3–4 aNSCLC patients receiving compassionate nivolumab were accrued by 12 French thoracic oncology departments, over 24 months. Overall survival (OS) was calculated using the Kaplan-Meier method. Prognostic variables were assessed using Cox proportional hazards models. Overall, 35 PS 3–4 aNSCLC patients (median age 65 years) received a median of 4 nivolumab infusions (interquartile range [IQR], 1–7) as first- (n = 6) or second-line (n = 29) therapy. At a median of 52-month follow-up (95%CI, 41–63), 32 (91%) patients had died. Median progression-free survival was 2.1 months (95%CI, 1.1–3.2). Median OS was 4.4 months (95%CI, 0.5–8.2). Overall, 20% of patients were alive at 1 year, and 14% at 2 years. Treatment-related adverse events occurred in 8/35 patients (23%), mostly of low-grade. After adjustment, brain metastases (HR = 5.2; 95%CI, 9–14.3, p = 0.001) and p = 0.003) predicted worse survival. PS improvement from 3–4 to 0–1 (n = 9) led to a median 43-month (95%CI, 0–102) OS. Certain patients with very poor general condition could derive long-term benefit from nivolumab salvage therapy.

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