Performance status modulates survival benefit of ICIs in advanced urothelial cancer
medwireNews: A poor ECOG performance status (PS) negatively impacts overall survival (OS) in patients with advanced urothelial cancer taking immune checkpoint inhibitors (ICIs), shows a real-world study.
These findings therefore suggest that “ICIs may not overcome the negative prognostic role of a poor PS” in this patient population, say Petros Grivas (Seattle Cancer Care Alliance, Washington, USA) and colleagues.
They add, however, that the overall response to ICIs was not hampered by a poor ECOG score.
As reported in Cancer, of the 499 patients who received ICIs for locally advanced, unresectable, or metastatic urothelial cancer at one of 18 institutions, 395 and 384 were included in the OS and overall response analyses, respectively, with just over half using ICIs as first-line therapy, while the remainder took them as second- or later-line.
Overall response rates following ICI treatment were comparable between patients with an ECOG PS of 0–1 and at least 2, both in the first-line and second- or later-line groups, at 31% versus 33%, and 27% versus 23%, respectively.
However, median OS was significantly longer among patients with better ECOG scores who received ICIs in the first-line. The median OS differed by 8 months between patients with high and low ECOG PS, with durations of 15.2 and 7.2 months among those with an ECOG PS of 0–1 or at least 2, respectively.
For patients given an ICI as a second- or later-line treatment, the median OS times were not significantly different, at 9.8 and 8.2 months for patients with an ECOG PS of 0–1 and 2 or more, respectively.
Further analysis showed that for patients with an ECOG PS of 3 the median OS ranged from 3.4 to 3.7 months depending on the line of ICI treatment, and no patients with this PS achieved an overall response, which prompted the investigators to speculate that “those with an ECOG PS of 3 are unlikely to benefit from ICIs.”
Additionally, the investigators found that among the 288 patients who died, those who started taking an ICI in the preceding 30 days were significantly more likely to die in a hospital versus elsewhere, but this was not the case if they initiated ICI treatment in the final 90 days of their life.
They conclude: “ICIs started near the [end of life] are associated with increased odds of death in the hospital,” and they therefore propose that “the decision of ICI initiation near the [end of life], akin to the practice for chemotherapy, should be considered carefully.”
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