Does Very Poor Performance Status Systematically Preclude Single Agent Anti-PD-1 Immunotherapy? A Multicenter Study...

Area of Science:

• Oncology
• Immunotherapy
• Thoracic Medicine

Background:

• Anti-PD-1 antibodies improve survival in advanced non-small-cell lung cancer (aNSCLC) patients with good performance status (PS 0-1).
• Efficacy of these agents in patients with poor performance status (PS 3-4) remains largely unknown.

Purpose of the Study:

• To evaluate the efficacy and safety of nivolumab in PS 3-4 aNSCLC patients.
• To identify prognostic factors for survival in this patient population.

Main Methods:

• A prospective study of 35 PS 3-4 aNSCLC patients receiving compassionate nivolumab across 12 French centers.
• Overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan-Meier method.
• Prognostic variables were assessed using Cox proportional hazards models.

Main Results:

• Median OS was 4.4 months, with 20% and 14% of patients alive at 1 and 2 years, respectively.
• Median PFS was 2.1 months.
• Treatment-related adverse events occurred in 23% of patients, mostly low-grade. Brain metastases and <20 pack-years predicted worse survival.
• Performance status improvement (PS 3-4 to 0-1) was observed in 9 patients, leading to a median OS of 43 months.

Conclusions:

• Nivolumab offers limited survival benefit for most PS 3-4 aNSCLC patients.
• A subset of patients with very poor general condition may achieve long-term benefit from nivolumab salvage therapy.
• Performance status improvement is a significant predictor of long-term survival in this cohort.