Journal article
Impact of performance status on treatment outcomes: A real-world study of advanced urothelial cancer treated with checkpoint inhibitors
Cancer, Vol.126(6), pp.1208-1216
12/12/2019
DOI: 10.1002/cncr.32645
PMCID: PMC7050422
PMID: 31829450
Abstract
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.
Details
- Title: Subtitle
- Impact of performance status on treatment outcomes: A real-world study of advanced urothelial cancer treated with checkpoint inhibitors
- Creators
- Ali Raza Khaki - University of WashingtonAng Li - University of WashingtonLeonidas N. Diamantopoulos - University of WashingtonMehmet A. Bilen - Emory UniversityVictor Santos - University of UtahJohn Esther - University of UtahRafael Morales-Barrera - Universitat Autònoma de BarcelonaMichael Devitt - University of VirginiaAriel Nelson - University Hospitals Cleveland Medical CenterChristopher J. Hoimes - University Hospitals Cleveland Medical CenterEvan Shreck - Montefiore Medical CenterHussein Assi - Oklahoma State University Oklahoma CityBenjamin A. Gartrell - Montefiore Medical CenterAlex Sankin - Montefiore Medical CenterAlejo Rodriguez-Vida - Hosp del Mar Res Inst, Dept Med Oncol, Barcelona, SpainMark Lythgoe - Imperial College LondonDavid J. Pinato - Imperial College LondonAlexandra Drakaki - University of California, Los AngelesMonika Joshi - Penn State Milton S. Hershey Medical CenterPedro Isaacsson Velho - Sidney Kimmel Comprehens Canc Ctr, Dept Oncol, Baltimore, MD USANoah Hahn - Sidney Kimmel Comprehensive Cancer CenterSandy Liu - University of California, Los AngelesLucia Alonso Buznego - Marqués de Valdecilla University HospitalIgnacio Duran - Marqués de Valdecilla University HospitalMarcus Moses - Tulane UniversityJayanshu Jain - University of IowaJure Murgic - Sisters Char Zagreb Sch Med, Univ Hosp Ctr, Dept Oncol & Nucl Med, Zagreb, CroatiaPraneeth Baratam - Drexel UniversityPedro Barata - Tulane UniversityAbhishek Tripathi - Oklahoma State University Oklahoma CityYousef Zakharia - University of IowaMatthew D. Galsky - Icahn School of Medicine at Mount SinaiGuru Sonpavde - Dana-Farber Cancer InstituteEvan Y. Yu - University of WashingtonVeena Shankaran - University of WashingtonGary H. Lyman - University of WashingtonPetros Grivas - University of Washington
- Resource Type
- Journal article
- Publication Details
- Cancer, Vol.126(6), pp.1208-1216
- DOI
- 10.1002/cncr.32645
- PMID
- 31829450
- PMCID
- PMC7050422
- NLM abbreviation
- Cancer
- ISSN
- 0008-543X
- eISSN
- 1097-0142
- Publisher
- Wiley
- Number of pages
- 9
- Grant note
- Cancer Research UK Imperial Centre Imperial Experimental Cancer Medicine Centre Seattle Translational Tumor Research Program at the Fred Hutchinson Cancer Research Center Merck; Merck & Company PS3416 / Wellcome Trust Strategic Fund; Wellcome Trust UL1 TR002319 / National Center for Advancing Translational Sciences of the National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS) T32CA009515 / National Cancer Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI)
- Language
- English
- Date published
- 12/12/2019
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984548377902771
Metrics
6 Record Views