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Wells L, Cerniglia M, Hall S, Jost AC, Britt G. Treatment of Metastatic Disease with Immune Checkpoint Inhibitors Nivolumab and Pembrolizumab: Effect of Performance Status on Clinical Outcomes. Journal of Immunotherapy and Precision Oncology 2022; 5:37-42. [PMID: 35664089 PMCID: PMC9153247 DOI: 10.36401/jipo-22-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/09/2022]
Abstract
ABSTRACT
Introduction
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.
Methods
Patients (n = 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 χ2 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.
Results
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.
Conclusion
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.
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Affiliation(s)
- Leah Wells
- Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA
| | - Michael Cerniglia
- Department of Internal Medicine, St. Joseph Hospital/SCL Health, Denver, CO, USA
| | - Sarah Hall
- Cancer Centers of Colorado, St. Joseph Hospital/SCL Health, Denver, CO, USA
| | - Audrey C. Jost
- Cancer Centers of Colorado, St. Joseph Hospital/SCL Health, Denver, CO, USA
| | - Gregory Britt
- Cancer Centers of Colorado, St. Joseph Hospital/SCL Health, Denver, CO, USA
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Vedula RS, Britt G, Kopelman RI, Rencic J. Complementary medicine. J Gen Intern Med 2014; 29:412-6. [PMID: 24197631 PMCID: PMC3912295 DOI: 10.1007/s11606-013-2636-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 08/06/2013] [Accepted: 09/10/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Rahul S Vedula
- Tufts University School of Medicine, 180 Washington St. Apt. 1, Brighton, Boston, MA, 02135, USA,
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Britt G. Operating room nursing: a rewarding profession. Todays OR Nurse 1987; 9:13-5. [PMID: 3645938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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