PMID- 32417680
OWN - NLM
STAT- MEDLINE
DCOM- 20210621
LR  - 20210621
IS  - 1872-8332 (Electronic)
IS  - 0169-5002 (Linking)
VI  - 145
DP  - 2020 Jul
TI  - ECOG performance status >/=2 as a prognostic factor in patients with advanced non 
      small cell lung cancer treated with immune checkpoint inhibitors-A systematic 
      review and meta-analysis of real world data.
PG  - 95-104
LID - S0169-5002(20)30398-6 [pii]
LID - 10.1016/j.lungcan.2020.04.027 [doi]
AB  - OBJECTIVES: ICIs have been approved and are routinely administered regardless of 
      performance status (PS), despite randomized clinical trials of ICIs alone or 
      combined with chemotherapy or target therapy enrolled patients with ECOG PS 0 or 
      1, while patients with ECOG PS 2 or more were excluded. MATERIALS AND METHODS: We 
      carried out a meta-analysis of available clinical studies exploring the 
      prognostic impact of PS >/= 2 on Overall Survival (OS), Progression Free Survival 
      (PFS) or Overall Response Rate (ORR) in patients with non small cell lung cancer 
      (NSCLC) treated with immunotherapy (any line). RESULTS: We reviewed 19 studies, 
      comprising 3600 NSCLC patients, 757 of whom with ECOG PS > 1 (average 21.0%, 
      range 6.0-48.6%). In the overall population PS >/= 2 resulted in worse OS, PFS and 
      ORR (OS pooled hazard ratio of 2.72; 95% CI: 2.03-3.63; I(2) 72.70%, p < 0.001; 
      PFS pooled hazard ratio of 2.39; 95% CI 1.81-3.15, p < 0.0001; I(2) 73.03%; ORR 
      pooled odds ratio 0.25; 95% CI 0.11-0.56, p 0.001; I(2) 0.00%). CONCLUSION: ECOG 
      PS >/= 2 retains an important prognostic validity in patients treated with ICI 
      similar, in terms of effect size, to that reported for chemotherapy in NSCLC. The 
      high level of heterogeneity for OS and PFS analysis (but not for ORR), not 
      completely explained by the different proportion of ECOG 3-4 patients (ranging 
      from 0% to 50% of the PS >/= 2 population), could be the result of both patient 
      heterogeneity within the PS 2 population and the subjectivity of ECOG PS 
      assessment. Whether poorer PS is also a predictor of lower immunotherapy efficacy 
      remains still to be demonstrated.
CI  - Copyright (c) 2020 Elsevier B.V. All rights reserved.
FAU - Dall'Olio, Filippo G
AU  - Dall'Olio FG
AD  - Sant'Orsola Malpighi Teaching Hospital - University of Bologna, Medical Oncology 
      Unit, Bologna, Italy. Electronic address: filippogdallolio@gmail.com.
FAU - Maggio, Ilaria
AU  - Maggio I
AD  - Sant'Orsola Malpighi Teaching Hospital - University of Bologna, Medical Oncology 
      Unit, Bologna, Italy.
FAU - Massucci, Maria
AU  - Massucci M
AD  - Sant'Orsola Malpighi Teaching Hospital - University of Bologna, Medical Oncology 
      Unit, Bologna, Italy.
FAU - Mollica, Veronica
AU  - Mollica V
AD  - Sant'Orsola Malpighi Teaching Hospital - University of Bologna, Medical Oncology 
      Unit, Bologna, Italy.
FAU - Fragomeno, Benedetta
AU  - Fragomeno B
AD  - Sant'Orsola Malpighi Teaching Hospital - University of Bologna, Medical Oncology 
      Unit, Bologna, Italy.
FAU - Ardizzoni, Andrea
AU  - Ardizzoni A
AD  - Sant'Orsola Malpighi Teaching Hospital - University of Bologna, Medical Oncology 
      Unit, Bologna, Italy.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20200506
PL  - Ireland
TA  - Lung Cancer
JT  - Lung cancer (Amsterdam, Netherlands)
JID - 8800805
RN  - 0 (Immune Checkpoint Inhibitors)
SB  - IM
MH  - *Carcinoma, Non-Small-Cell Lung/diagnosis/drug therapy
MH  - Humans
MH  - Immune Checkpoint Inhibitors
MH  - Immunotherapy
MH  - *Lung Neoplasms/diagnosis/drug therapy
MH  - Prognosis
OTO - NOTNLM
OT  - Atezolizumab
OT  - Carcinoma
OT  - Frail elderly
OT  - Humans
OT  - Immunologic factors
OT  - Immunotherapy
OT  - Lung neoplasms
OT  - Nivolumab
OT  - Non-small-cell lung
OT  - Pembrolizumab
OT  - Prognosis
COIS- Declaration of Competing Interest The other authors have no conflict of interest 
      to declare.
EDAT- 2020/05/18 06:00
MHDA- 2021/06/22 06:00
CRDT- 2020/05/18 06:00
PHST- 2019/12/03 00:00 [received]
PHST- 2020/04/05 00:00 [revised]
PHST- 2020/04/21 00:00 [accepted]
PHST- 2020/05/18 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2020/05/18 06:00 [entrez]
AID - S0169-5002(20)30398-6 [pii]
AID - 10.1016/j.lungcan.2020.04.027 [doi]
PST - ppublish
SO  - Lung Cancer. 2020 Jul;145:95-104. doi: 10.1016/j.lungcan.2020.04.027. Epub 2020 
      May 6.