The performance status gap in immunotherapy for frail patients with advanced non-small cell lung cancer.

Autor: Wu JT; VA Palo Alto Healthcare System, Stanford University, Palo Alto, CA, USA., Corrigan J; VA Boston Healthcare System, Boston, USA., Su C; Stanford University, Palo Alto, CA, USA., Dumontier C; VA Boston Healthcare System, Harvard Medical School, Boston, USA., La J; VA Boston Healthcare System, Harvard Medical School, Boston, USA., Khan A; Stanford University, Palo Alto, CA, USA., Arya S; VA Palo Alto Healthcare System, Stanford University, Palo Alto, CA, USA., Harris AHS; VA Palo Alto Healthcare System, Stanford University, Palo Alto, CA, USA., Backhus L; VA Palo Alto Healthcare System, Stanford University, Palo Alto, CA, USA., Das M; VA Palo Alto Healthcare System, Stanford University, Palo Alto, CA, USA., Do NV; VA Boston Healthcare System, Boston University School of Medicine, Boston, USA., Brophy MT; VA Boston Healthcare System, Boston University School of Medicine, Boston, USA., Han SS; Stanford University, Palo Alto, CA, USA., Kelley M; Durham VA Healthcare System, Duke University, Durham, NC, USA., Fillmore NR; VA Boston Healthcare System, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA. Nathanael_Fillmore@dfci.harvard.edu.; Massachusetts Veterans Epidemiology Research and Information Center, 150 S Huntington Ave, Boston, MA, 02141, USA. Nathanael_Fillmore@dfci.harvard.edu.
Jazyk: angličtina
Zdroj: Cancer immunology, immunotherapy : CII [Cancer Immunol Immunother] 2024 Jul 02; Vol. 73 (9), pp. 172. Date of Electronic Publication: 2024 Jul 02.
DOI: 10.1007/s00262-024-03763-w
Abstrakt: Purpose: In advanced non-small cell lung cancer (NSCLC), immune checkpoint inhibitor (ICI) monotherapy is often preferred over intensive ICI treatment for frail patients and those with poor performance status (PS). Among those with poor PS, the additional effect of frailty on treatment selection and mortality is unknown.
Methods: Patients in the veterans affairs national precision oncology program from 1/2019-12/2021 who received first-line ICI for advanced NSCLC were followed until death or study end 6/2022. Association of an electronic frailty index with treatment selection was examined using logistic regression stratified by PS. We also examined overall survival (OS) on intensive treatment using Cox regression stratified by PS. Intensive treatment was defined as concurrent use of platinum-doublet chemotherapy and/or dual checkpoint blockade and non-intensive as ICI monotherapy.
Results: Of 1547 patients receiving any ICI, 66.2% were frail, 33.8% had poor PS (≥ 2), and 25.8% were both. Frail patients received less intensive treatment than non-frail patients in both PS subgroups (Good PS: odds ratio [OR] 0.67, 95% confidence interval [CI] 0.51 - 0.88; Poor PS: OR 0.69, 95% CI 0.44 - 1.10). Among 731 patients receiving intensive treatment, frailty was associated with lower OS for those with good PS (hazard ratio [HR] 1.53, 95% CI 1.2 - 1.96), but no association was observed with poor PS (HR 1.03, 95% CI 0.67 - 1.58).
Conclusion: Frail patients with both good and poor PS received less intensive treatment. However, frailty has a limited effect on survival among those with poor PS. These findings suggest that PS, not frailty, drives survival on intensive treatment.
(© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
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