The performance status gap in immunotherapy for frail patients with advanced non-small cell lung cancer
Abstract 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 selec...
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| Format: | Article |
| Language: | English |
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Springer
2024-07-01
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| Series: | Cancer Immunology, Immunotherapy |
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| Online Access: | https://doi.org/10.1007/s00262-024-03763-w |
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| author | Julie Tsu-Yu Wu June Corrigan Chloe Su Clark Dumontier Jennifer La Aparjita Khan Shipra Arya Alex H. S. Harris Leah Backhus Millie Das Nhan V. Do Mary T. Brophy Summer S. Han Michael Kelley Nathanael R. Fillmore |
| author_facet | Julie Tsu-Yu Wu June Corrigan Chloe Su Clark Dumontier Jennifer La Aparjita Khan Shipra Arya Alex H. S. Harris Leah Backhus Millie Das Nhan V. Do Mary T. Brophy Summer S. Han Michael Kelley Nathanael R. Fillmore |
| author_sort | Julie Tsu-Yu Wu |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-b2f1637776a347d0bc82576eb6d6b524 |
| institution | Kabale University |
| issn | 1432-0851 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Springer |
| record_format | Article |
| series | Cancer Immunology, Immunotherapy |
| spelling | doaj-art-b2f1637776a347d0bc82576eb6d6b5242025-01-05T12:31:23ZengSpringerCancer Immunology, Immunotherapy1432-08512024-07-0173911110.1007/s00262-024-03763-wThe performance status gap in immunotherapy for frail patients with advanced non-small cell lung cancerJulie Tsu-Yu Wu0June Corrigan1Chloe Su2Clark Dumontier3Jennifer La4Aparjita Khan5Shipra Arya6Alex H. S. Harris7Leah Backhus8Millie Das9Nhan V. Do10Mary T. Brophy11Summer S. Han12Michael Kelley13Nathanael R. Fillmore14VA Palo Alto Healthcare System, Stanford UniversityVA Boston Healthcare SystemStanford UniversityVA Boston Healthcare System, Harvard Medical SchoolVA Boston Healthcare System, Harvard Medical SchoolStanford UniversityVA Palo Alto Healthcare System, Stanford UniversityVA Palo Alto Healthcare System, Stanford UniversityVA Palo Alto Healthcare System, Stanford UniversityVA Palo Alto Healthcare System, Stanford UniversityVA Boston Healthcare System, Boston University School of MedicineVA Boston Healthcare System, Boston University School of MedicineStanford UniversityDurham VA Healthcare System, Duke UniversityVA Boston Healthcare System, Dana-Farber Cancer Institute, Harvard Medical SchoolAbstract 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.https://doi.org/10.1007/s00262-024-03763-wFrailtyPerformance statusLung cancer |
| spellingShingle | Julie Tsu-Yu Wu June Corrigan Chloe Su Clark Dumontier Jennifer La Aparjita Khan Shipra Arya Alex H. S. Harris Leah Backhus Millie Das Nhan V. Do Mary T. Brophy Summer S. Han Michael Kelley Nathanael R. Fillmore The performance status gap in immunotherapy for frail patients with advanced non-small cell lung cancer Cancer Immunology, Immunotherapy Frailty Performance status Lung cancer |
| title | The performance status gap in immunotherapy for frail patients with advanced non-small cell lung cancer |
| title_full | The performance status gap in immunotherapy for frail patients with advanced non-small cell lung cancer |
| title_fullStr | The performance status gap in immunotherapy for frail patients with advanced non-small cell lung cancer |
| title_full_unstemmed | The performance status gap in immunotherapy for frail patients with advanced non-small cell lung cancer |
| title_short | The performance status gap in immunotherapy for frail patients with advanced non-small cell lung cancer |
| title_sort | performance status gap in immunotherapy for frail patients with advanced non small cell lung cancer |
| topic | Frailty Performance status Lung cancer |
| url | https://doi.org/10.1007/s00262-024-03763-w |
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