Nivolumab versus best supportive care bij NSCLC-patiënten met slechte performance status

INTRODUCTION: Non small cell lung cancer (NSCLC) patients with poor Eastern Cooperative Oncology Group Performance Status (ECOG PS >2) represent a challenging subset of patients. Best supportive care (BSC) has been the standard of care as per NCCN guidelines in this cohort; however immune checkpoint inhibitors have a potential of offering better tolerance and survival benefits. This study aimed to compare outcomes of immunotherapy versus BSC in NSCLC patients with PS>2. METHODS: This is a retrospective analysis of NSCLC patients who have progressed on initial lines of therapy and had ECOG PS 3 or 4. A propensity score matching was conducted between the two groups- those who received immune checkpoint inhibitors (nivolumab group) and those who were managed with BSC (BSC group) using the variables of age, sex, smoking status, stage and tumor type. The final study cohort included 39 patients in nivolumab arm and 21 in BSC arm. Baseline demographics, treatment responses, overall survival (OS), and adverse events were compared. RESULTS: Most patients were males (81.7%), smokers (85%), and had stage IV disease (75%), and squamous histology (70%). PDL1 status was unknown in 53.3%. All patients had initially received platinum-based-doublet chemotherapy. Compared to the nivolumab group, the BSC group had a higher proportion of ECOG 4 patients (80.9% vs 35.9%, p<0.001), while more nivolumab patients had PDL1 levels of 1-49% (30.8% vs 14.3%, p=0.003). Median progression-free survival in the nivolumab group was 18-weeks, with 25.6% remaining progression-free at data cutoff. Median OS was significantly longer with nivolumab: 29-weeks (95% CI: 11.3-46.7) versus 8-weeks (95% CI: 3.5-12.5; p<0.001) with adjusted-hazard-ratio of 0.243 (95% CI: 0.106-0.56; p<0.001). In the nivolumab group, 23.1% had partial-responses, and 41% showed at least one-point improvement in PS (4.8% in the BSC group). CONCLUSION: Immunotherapy demonstrated superior survival outcomes and acceptable tolerability profile than BSC in NSCLC patients with PS >2.