Impact of performance status on non-small-cell lung cancer patients with a PD-L1 tumour proportion score ≥50% treated with front-line pembrolizumab
Alex Friedlaender, Giulio Metro, Diego Signorelli, Alessio Gili, Panagiota Economopoulou, Fausto Roila, Giuseppe Luigi Banna, Alessandro De Toma, Andrea Camerini, Athina Christopoulou, Giuseppe Lo Russo, Marco Banini, Domenico Galetta, Beatriz Jiménez, Ana Collazo-Lorduy, Antonio Calles, Panagiotis Baxevanos, Helena Linardou, P. Kosmidis, Giannis Mountzios, Marina Chiara Garassino, Alfredo Addeo
Abstract
Objectives: We retrospectively analysed patients with advanced non-small-cell lung cancer (NSCLC) harbouring high PD-L1 expression (>50%) and treated with front-line pembrolizumab, comparing outcomes of patients with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 to those with PS 0-1.Methods: Data were collected by 16 participating centres. All patients with NSCLC and high PD-L1, treated with first-line pembrolizumab were included. We collected medical data from patient files, pathology and laboratory reports. Patient characteristics, comorbidities, PS, and tumour characteristics were reported. Overall survival (OS), progression-free survival (PFS) and response rate (RR) were calculated.Results: 302 patients were included, 246 with PS 0-1, 56 with PS 2. RR was 72% among patients with PS 0-1 compared to 45% with PS2 (odds ratio (OR) 0.31 (95% CI: 0.17–0.57), p < .001). Median PFS was 2.6 months (95% CI: 1.9–5.1) among patients with PS2 and 11.3 months (95% CI: 8.5–14.4) among those with PS 0-1. Median OS was 7.8 months (95% CI: 2.5–10.7) in the PS2 group, not reached in the PS 0-1 group. PS 2 remained predictive of poor outcomes in multivariate analysis.Conclusion: PS 2 is a strong independent predictor of poor response and survival in NSCLC patients with high PD-L1, treated with front-line pembrolizumab. Prospective randomised trials comparing immunotherapy to chemotherapy in this population would be welcome.