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Impact of performance status on treatment outcomes: A real‐world study of advanced urothelial cancer treated with immune checkpoint inhibitors

2019; Wiley; Volume: 126; Issue: 6 Linguagem: Inglês

10.1002/cncr.32645

1097-0142

Ali Raza Khaki, Ang Li, Leonidas Nikolaos Diamantopoulos, Mehmet Asım Bilen, Víctor Sacristán Santos, John Esther, Rafael Morales‐Barrera, Michael Devitt, Ariel Ann Nelson, Christopher Hoimes, Evan Shreck, Hussein A. Assi, Benjamin A. Gartrell, Alex Sankin, Alejo Rodríguez‐Vida, Mark P. Lythgoe, David J. Pinato, Alexandra Drakaki, Monika Joshi, Pedro Isaacsson Velho, Noah M. Hahn, Sandy Liu, Lucía Alonso Buznego, Ignacio Durán, Marcus Marie Moses, Jayanshu Jain, Jure Murgić, Praneeth Baratam, Pedro Barata, Abhishek Tripathi, Yousef Zakharia, Matthew D. Galsky, Guru Sonpavde, Evan Y. Yu, Veena Shankaran, Gary H. Lyman, Petros Grivas,

Cancer Immunotherapy and Biomarkers

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.