Clinical Effectiveness of Immune Checkpoint Inhibitors in Non-Small-Cell Lung Cancer with a Poor Performance Status
Kyoichi Kaira1, Hisao Imai1, Atsuto Mouri1
1Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama 350-1298, Japan.
Abstract:
Immune checkpoint inhibitors (ICIs) are standard treatments for patients with lung cancer. PD-1/PD-L1 or CTLA4 antibodies are chosen as the first-line therapy, contributing to the long-term survival and tolerability. Unlike molecular targeting agents, such as gefitinib, lung cancer patients with a poor performance status (PS) display unsatisfactory clinical improvements after ICI treatment. Several previous reports also demonstrated that the PS is identified as one of the most probable prognostic factors for predicting poor outcomes after ICI treatment. However, first-line pembrolizumab seemed to be effective for lung cancer patients with a PS of 2 if PD-L1 expression was greater than 50%. Currently, the induction of ICIs in patients with lung cancer with a poor PS is controversial. These problems are discussed in this review.
Insights
Immune checkpoint inhibitors (ICIs) show promise in lung cancer treatment. However, their efficacy in patients with poor performance status (PS) remains controversial, necessitating further investigation.
Area of Science:
- Oncology
- Immunotherapy
Background:
- Immune checkpoint inhibitors (ICIs) like PD-1/PD-L1 and CTLA4 antibodies are standard first-line lung cancer therapies.
- While beneficial for long-term survival and tolerability, ICIs show limited clinical improvement in lung cancer patients with poor performance status (PS).
Purpose of the Study:
- To review the current understanding and controversies surrounding the use of ICIs in lung cancer patients with poor PS.
- To analyze the prognostic significance of PS in predicting outcomes after ICI treatment.
Main Methods:
- Review of existing literature on ICI efficacy in lung cancer.
- Analysis of performance status (PS) as a prognostic factor for ICI therapy.
- Discussion of specific findings, such as the effectiveness of pembrolizumab in PS 2 patients with high PD-L1 expression.
Main Results:
- Performance status (PS) is a significant predictor of poor outcomes in lung cancer patients receiving ICIs.
- First-line pembrolizumab may be effective in select lung cancer patients with PS 2 and PD-L1 expression >50%.
Conclusions:
- The use of ICIs in lung cancer patients with poor PS is currently debated.
- Further research is needed to clarify the role and optimal selection criteria for ICIs in this patient subgroup.
