Does Very Poor Performance Status Systematically Preclude Single Agent Anti-PD-1 Immunotherapy? A Multicenter Study of 35 Consecutive Patients

Cancers

Marie Wislez¹  Carole Helissey²  Jean-Philippe Spano³  Ludovic Doucet⁴  Aurélie Cazes⁵  Xavier Dhalluin⁶  Jacques Cadranel⁷  Christos Chouaid⁸  Olivier Molinier⁹  José Hureaux^1,10  Sylvie Van Hulst^1,11  Ghassen Soussi^1,12  Gérard Zalcman^1,12  Valérie Gounant^1,12  Jean Trédaniel^1,13  Michael Duruisseaux^1,14  Olivier Bylicki^1,15 

[1] Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, INSERM, TeamInflammation, Complement, and Cancer, F-75006 Paris, France;Clinical Research Unit, Hôpital d’Instruction des Armées Bégin, 94160 Saint-Mandé, France;Department of Medical Oncology, Pitié-Salpétrière Hospital, APHP, Sorbonne Université, 75013 Paris, France;Department of Oncology, Saint Louis Hospital, APHP, 75010 Paris, France;Department of Pathology, Bichat Claude Bernard Hospital, APHP, Université de Paris, 75018 Paris, France;Department of Pneumology and Thoracic Oncology, Calmette Hospital, Centre Hospitalier Universitaire de Lille, 59000 Lille, France;Department of Pneumology and Thoracic Oncology, Tenon Hospital, APHP, GRC Theranoscan and Curamus Sorbonne Université, 75020 Paris, France;Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, University Paris–Est Créteil (UPEC), CEpiA (Clinical Epidemiology and Ageing), EA 7376-IMRB, 94000 Créteil, France;Department of Pneumology, Centre Hospitalier Le Mans, 72037 Le Mans, France;Department of Pneumology, Pôle Hippocrate, University Hospital of Angers, 49100 Angers, France;Department of Pneumology, University Hospital of Nîmes, 30900 Nîmes, France;Department of Thoracic Oncology, Bichat Claude Bernard Hospital, APHP, CIC Inserm 1425, Université de Paris, 75018 Paris, France;Groupe Hospitalier Paris Saint-Joseph, Department of Pneumology, Université de Paris, Sorbonne Paris Cité, Unité INSERM UMR-S 1124, 75014 Paris, France;Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon, 69002 Lyon, France;Respiratory Disease Unit, Hôpital d’Instruction des Armées Sainte-Anne, 83800 Toulon, France;

关键词: non-small cell lung cancer;    poor performance status;    immunotherapy;    nivolumab;    brain metastases;   

DOI  :  10.3390/cancers13051040

来源: DOAJ

【 摘 要 】

Anti-PD-1 antibodies prolong survival of performance status (PS) 0–1 advanced non-small-cell lung cancer (aNSCLC) patients. Their efficacy in PS 3–4 patients is unknown. Conse- cutive PS 3–4 aNSCLC patients receiving compassionate nivolumab were accrued by 12 French thoracic oncology departments, over 24 months. Overall survival (OS) was calculated using the Kaplan-Meier method. Prognostic variables were assessed using Cox proportional hazards models. Overall, 35 PS 3–4 aNSCLC patients (median age 65 years) received a median of 4 nivolumab infusions (interquartile range [IQR], 1–7) as first- (n = 6) or second-line (n = 29) therapy. At a median of 52-month follow-up (95%CI, 41–63), 32 (91%) patients had died. Median progression-free survival was 2.1 months (95%CI, 1.1–3.2). Median OS was 4.4 months (95%CI, 0.5–8.2). Overall, 20% of patients were alive at 1 year, and 14% at 2 years. Treatment-related adverse events occurred in 8/35 patients (23%), mostly of low-grade. After adjustment, brain metastases (HR = 5.2; 95%CI, 9–14.3, p = 0.001) and <20 pack-years (HR = 4.8; 95%CI, 1.7–13.8, p = 0.003) predicted worse survival. PS improvement from 3–4 to 0–1 (n = 9) led to a median 43-month (95%CI, 0–102) OS. Certain patients with very poor general condition could derive long-term benefit from nivolumab salvage therapy.

【 授权许可】

Unknown