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

Publication ,  Journal Article
Khaki, AR; Li, A; Diamantopoulos, LN; Bilen, MA; Santos, V; Esther, J; Morales-Barrera, R; Devitt, M; Nelson, A; Hoimes, CJ; Shreck, E; Liu, S ...
Published in: Cancer
March 15, 2020

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.

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Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

March 15, 2020

Volume

126

Issue

6

Start / End Page

1208 / 1216

Location

United States

Related Subject Headings

  • Urologic Neoplasms
  • Treatment Outcome
  • Severity of Illness Index
  • Retrospective Studies
  • Proportional Hazards Models
  • Programmed Cell Death 1 Receptor
  • Oncology & Carcinogenesis
  • Male
  • Kaplan-Meier Estimate
  • Immunotherapy
 

Citation

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Khaki, A. R., Li, A., Diamantopoulos, L. N., Bilen, M. A., Santos, V., Esther, J., … Grivas, P. (2020). Impact of performance status on treatment outcomes: A real-world study of advanced urothelial cancer treated with immune checkpoint inhibitors. Cancer, 126(6), 1208–1216. https://doi.org/10.1002/cncr.32645
Khaki, Ali Raza, Ang Li, Leonidas N. Diamantopoulos, Mehmet A. Bilen, Victor Santos, John Esther, Rafael Morales-Barrera, et al. “Impact of performance status on treatment outcomes: A real-world study of advanced urothelial cancer treated with immune checkpoint inhibitors.Cancer 126, no. 6 (March 15, 2020): 1208–16. https://doi.org/10.1002/cncr.32645.
Khaki AR, Li A, Diamantopoulos LN, Bilen MA, Santos V, Esther J, et al. Impact of performance status on treatment outcomes: A real-world study of advanced urothelial cancer treated with immune checkpoint inhibitors. Cancer. 2020 Mar 15;126(6):1208–16.
Khaki, Ali Raza, et al. “Impact of performance status on treatment outcomes: A real-world study of advanced urothelial cancer treated with immune checkpoint inhibitors.Cancer, vol. 126, no. 6, Mar. 2020, pp. 1208–16. Pubmed, doi:10.1002/cncr.32645.
Khaki AR, Li A, Diamantopoulos LN, Bilen MA, Santos V, Esther J, Morales-Barrera R, Devitt M, Nelson A, Hoimes CJ, Shreck E, Assi H, Gartrell BA, Sankin A, Rodriguez-Vida A, Lythgoe M, Pinato DJ, Drakaki A, Joshi M, Isaacsson Velho P, Hahn N, Liu S, Alonso Buznego L, Duran I, Moses M, Jain J, Murgic J, Baratam P, Barata P, Tripathi A, Zakharia Y, Galsky MD, Sonpavde G, Yu EY, Shankaran V, Lyman GH, Grivas P. Impact of performance status on treatment outcomes: A real-world study of advanced urothelial cancer treated with immune checkpoint inhibitors. Cancer. 2020 Mar 15;126(6):1208–1216.
Journal cover image

Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

March 15, 2020

Volume

126

Issue

6

Start / End Page

1208 / 1216

Location

United States

Related Subject Headings

  • Urologic Neoplasms
  • Treatment Outcome
  • Severity of Illness Index
  • Retrospective Studies
  • Proportional Hazards Models
  • Programmed Cell Death 1 Receptor
  • Oncology & Carcinogenesis
  • Male
  • Kaplan-Meier Estimate
  • Immunotherapy