TY - JOUR
T1 - Impact of performance status on treatment outcomes
T2 - A real-world study of advanced urothelial cancer treated with immune checkpoint inhibitors
AU - Khaki, Ali Raza
AU - Li, Ang
AU - Diamantopoulos, Leonidas N.
AU - Bilen, Mehmet A.
AU - Santos, Victor
AU - Esther, John
AU - Morales-Barrera, Rafael
AU - Devitt, Michael
AU - Nelson, Ariel
AU - Hoimes, Christopher J.
AU - Shreck, Evan
AU - Assi, Hussein
AU - Gartrell, Benjamin A.
AU - Sankin, Alex
AU - Rodriguez-Vida, Alejo
AU - Lythgoe, Mark
AU - Pinato, David J.
AU - Drakaki, Alexandra
AU - Joshi, Monika
AU - Isaacsson Velho, Pedro
AU - Hahn, Noah
AU - Liu, Sandy
AU - Alonso Buznego, Lucia
AU - Duran, Ignacio
AU - Moses, Marcus
AU - Jain, Jayanshu
AU - Murgic, Jure
AU - Baratam, Praneeth
AU - Barata, Pedro
AU - Tripathi, Abhishek
AU - Zakharia, Yousef
AU - Galsky, Matthew D.
AU - Sonpavde, Guru
AU - Yu, Evan Y.
AU - Shankaran, Veena
AU - Lyman, Gary H.
AU - Grivas, Petros
N1 - Funding Information:
Ali Raza Khaki was supported by the National Cancer Institute under training grant T32CA009515. Research Electronic Data Capture at the Institute of Translational Health Sciences is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award UL1 TR002319. Evan Y. Yu and Petros Grivas acknowledge the support of the Seattle Translational Tumor Research Program at the Fred Hutchinson Cancer Research Center. David J. Pinato acknowledges support from the Imperial Experimental Cancer Medicine Centre and the Cancer Research UK Imperial Centre and grant funding from the Wellcome Trust Strategic Fund (PS3416). Matthew D. Galsky reports funding from Merck to support the study.
Publisher Copyright:
© 2019 American Cancer Society
PY - 2020/3/15
Y1 - 2020/3/15
N2 - Background: Immune checkpoint inhibitors (ICIs) represent an appealing treatment for patients with advanced urothelial cancer (aUC) and a poor performance status (PS). However, the benefit of ICIs for patients with a poor PS remains unknown. It was hypothesized that a poor Eastern Cooperative Oncology Group (ECOG) PS (≥2 vs 0-1) would correlate with shorter overall survival (OS) in patients receiving ICIs. Methods: In this retrospective cohort study, clinicopathologic, treatment, and outcome data were collected for patients with aUC who were treated with ICIs at 18 institutions (2013-2019). The overall response rate (ORR) and OS were compared for patients with an ECOG PS of 0 to 1 and patients with an ECOG PS ≥ 2 at ICI initiation. The association between a new ICI in the last 30 and 90 days of life (DOL) and death location was also tested. Results: Of the 519 patients treated with ICIs, 395 and 384 were included in OS and ORR analyses, respectively, with 26% and 24% having a PS ≥ 2. OS was higher in those with a PS of 0 to 1 than those with a PS ≥ 2 who were treated in the first line (median, 15.2 vs 7.2 months; hazard ratio [HR], 0.62; P =.01) but not in subsequent lines (median, 9.8 vs 8.2 months; HR, 0.78; P =.27). ORRs were similar for patients with a PS of 0 to 1 and patients with a PS ≥ 2 in both lines. Of the 288 patients who died, 10% and 32% started ICIs in the last 30 and 90 DOL, respectively. ICI initiation in the last 30 DOL was associated with increased odds of death in a hospital (odds ratio, 2.89; P =.04). Conclusions: Despite comparable ORRs, ICIs may not overcome the negative prognostic role of a poor PS, particularly in the first-line setting, and the initiation of ICIs in the last 30 DOL was associated with hospital death location.
AB - Background: Immune checkpoint inhibitors (ICIs) represent an appealing treatment for patients with advanced urothelial cancer (aUC) and a poor performance status (PS). However, the benefit of ICIs for patients with a poor PS remains unknown. It was hypothesized that a poor Eastern Cooperative Oncology Group (ECOG) PS (≥2 vs 0-1) would correlate with shorter overall survival (OS) in patients receiving ICIs. Methods: In this retrospective cohort study, clinicopathologic, treatment, and outcome data were collected for patients with aUC who were treated with ICIs at 18 institutions (2013-2019). The overall response rate (ORR) and OS were compared for patients with an ECOG PS of 0 to 1 and patients with an ECOG PS ≥ 2 at ICI initiation. The association between a new ICI in the last 30 and 90 days of life (DOL) and death location was also tested. Results: Of the 519 patients treated with ICIs, 395 and 384 were included in OS and ORR analyses, respectively, with 26% and 24% having a PS ≥ 2. OS was higher in those with a PS of 0 to 1 than those with a PS ≥ 2 who were treated in the first line (median, 15.2 vs 7.2 months; hazard ratio [HR], 0.62; P =.01) but not in subsequent lines (median, 9.8 vs 8.2 months; HR, 0.78; P =.27). ORRs were similar for patients with a PS of 0 to 1 and patients with a PS ≥ 2 in both lines. Of the 288 patients who died, 10% and 32% started ICIs in the last 30 and 90 DOL, respectively. ICI initiation in the last 30 DOL was associated with increased odds of death in a hospital (odds ratio, 2.89; P =.04). Conclusions: Despite comparable ORRs, ICIs may not overcome the negative prognostic role of a poor PS, particularly in the first-line setting, and the initiation of ICIs in the last 30 DOL was associated with hospital death location.
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U2 - 10.1002/cncr.32645
DO - 10.1002/cncr.32645
M3 - Article
C2 - 31829450
AN - SCOPUS:85076443880
SN - 0008-543X
VL - 126
SP - 1208
EP - 1216
JO - Cancer
JF - Cancer
IS - 6
ER -