Wells Leah, Cerniglia Michael, Hall Sarah, Jost Audrey C, Britt Gregory
Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA.
Department of Internal Medicine, St. Joseph Hospital/SCL Health, Denver, CO, USA.
J Immunother Precis Oncol. 2022 May 19;5(2):37-42. doi: 10.36401/JIPO-22-3. eCollection 2022 May.
Although guidelines exist for appropriate use of chemotherapy in the metastatic setting based on performance status, such recommendations are less readily available for immune checkpoint inhibitors (ICIs). We sought to determine whether there is a relationship between Eastern Cooperative Oncology Group (ECOG) performance status and outcomes of immunotherapy in patients treated for metastatic disease at our community-based oncology practice.
Patients ( = 253) were identified as receiving nivolumab or pembrolizumab for stage IV malignancy at Cancer Centers of Colorado, St. Joseph Hospital/SCL Health between June 2018 and November 2020. Patients who initiated therapy after May 2020 were excluded from analysis due to less than 6 months follow-up time. The remaining 183 patients were included in a retrospective cohort study comparing patients with ECOG 0, 1, and 2-4. Sex, age, type of cancer, line of therapy, time on therapy and best response to therapy were determined. These baseline factors and outcomes were compared using analysis of variance (ANOVA) for numeric variables and χ tests of association for categorical variables. Time from initiation of ICI to death or hospice was also compared using a log-rank test as well as a multivariate Cox proportional hazards model.
Of the 183 patients included, 31.7% had an ECOG of 0, 48.6% an ECOG of 1, and 19.7% an ECOG of 2-4. Non-small cell lung cancer and melanoma represented the majority of patients in each group. Sex and line of therapy did not differ between groups. There was a significant difference in age, with mean age of 62, 66, and 70 in ECOG 0, 1, and 2-4, respectively. Patients (54.6%) remained on therapy for at least 6 months, with no significant difference between groups in ability to complete 6 months of therapy. For ECOG 0, 1, and 2-4, disease control was achieved in 67.2%, 59.6%, and 41.7%, respectively. Analysis of time to death or hospice with a log-rank test showed a significant difference between groups. A multivariate Cox proportional hazards model revealed that patients with ECOG 0 had significantly longer time to death or hospice compared with patients in both other groups after controlling for age, sex, and line of therapy.
In this single institution retrospective study of patients receiving nivolumab or pembrolizumab for metastatic cancer, ECOG 0 was associated with disease control and increased time before death or transition to hospice.
尽管已存在基于体能状态指导转移性疾病化疗合理使用的指南，但针对免疫检查点抑制剂（ICI）的此类建议却不那么容易获得。我们试图确定东部肿瘤协作组（ECOG）体能状态与在我们社区肿瘤医疗实践中接受转移性疾病治疗患者的免疫治疗结果之间是否存在关联。
在2018年6月至2020年11月期间，在科罗拉多癌症中心、圣约瑟夫医院/SCL健康中心，确定253例接受纳武单抗或派姆单抗治疗IV期恶性肿瘤的患者。由于随访时间不足6个月，2020年5月之后开始治疗的患者被排除在分析之外。其余183例患者被纳入一项回顾性队列研究，比较ECOG 0、1和2 - 4级的患者。确定患者的性别、年龄、癌症类型、治疗线数、治疗时间和对治疗的最佳反应。使用方差分析（ANOVA）对数值变量进行比较，使用χ²检验对分类变量进行关联分析，比较这些基线因素和结果。还使用对数秩检验以及多变量Cox比例风险模型比较从ICI开始治疗到死亡或进入临终关怀的时间。
在纳入的183例患者中，31.7%的患者ECOG为0，48.6%的患者ECOG为1，19.7%的患者ECOG为2 - 4。非小细胞肺癌和黑色素瘤在每组患者中占大多数。各组之间性别和治疗线数无差异。年龄存在显著差异，ECOG 0、1和2 - 4级患者的平均年龄分别为62岁、66岁和70岁。54.6%的患者持续治疗至少6个月，各组完成6个月治疗的能力无显著差异。对于ECOG 0、1和2 - 4级患者，疾病控制率分别为67.2%、59.6%和41.7%。对数秩检验分析死亡或进入临终关怀的时间显示各组之间存在显著差异。多变量Cox比例风险模型显示，在控制年龄、性别和治疗线数后，ECOG 0级患者与其他两组患者相比，死亡或进入临终关怀的时间显著更长。
在这项针对接受纳武单抗或派姆单抗治疗转移性癌症患者的单机构回顾性研究中，ECOG 0级与疾病控制以及死亡或转至临终关怀前时间延长相关。
