Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

Efficacy and toxicity of immunotherapy in cancer patients with poor performance status (#231)

Helen Westman 1 , Marty Tio 1 , Malmaruha Arasaratnam 2 , Nick Pavlakis 1 3 , Alexander Guminski 1 3 4 , Adnan Nagrial 2 3 , Stephen Clarke 1 3 , Alexander M Menzies 1 3 4
  1. Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
  2. Crown Princess Mary Cancer Centre, Westmead Hospital , Sydney, NSW, Australia
  3. Sydney Medical School, University of Sydney, Sydney, NSW, Australia
  4. Melanoma Institute Australia, Sydney, NSW, Australia


We sought to determine the efficacy and toxicity of checkpoint immunotherapy in cancer patients (pts) who have a poor performance status (PS). 


Pts with advanced solid malignancy and treated with anti-PD-1 monotherapy between January 2014 and February 2017, with an Eastern Cooperative Oncology Group (ECOG) PS ≥ 2 at treatment commencement were included. Pts with a melanoma diagnosis were excluded. Retrospective data were audited from medical records at five facilities.  


Of the 49 pts eligible for inclusion, 37 (76%) pts had ECOG 2; 11 (22%) pts had ECOG 3; 1 (2%) pt had ECOG 4 status; 32 (65%) were male. Median age was 67 years. Of the 49 pts, 33 (67%) had non-small cell lung cancer. Twenty-seven (55%) had progress imaging; those without were assumed to have had progressive disease. There were no complete responses; four (8%) partial responses (PR); five (10%) with stable disease (SD); 40 (82%) with progressive disease. Median overall survival (mOS) was 4.9 months (95% confidence interval [CI] 3.6-6.3) with a mOS of 5.1 months (95%CI 3.1-7.1) in the ECOG 2 cohort; mOS of 4.3 months (95%CI 2.0-6.6) in the ECOG 3/4 cohort. The mOS of pts with PR/SD was 10.4 months (95%CI 6.2-14.6). Use of corticosteroids, hazard ratio (HR) 3.1 (95%CI 1.12-9.00); age less than 65, HR 2.3 (95%CI 1.17-4.63); and above median neutrophil-to-lymphocyte ratio, HR 4.48 (95%CI 1.46-13.73), were associated with decreased survival on univariate analysis. These prognostic factors were non-significant on multivariate analysis.  Nine pts (18%) had immune related adverse events, three (6%) discontinued due to toxicity.  Eight (16%) died within 30 days of initiation of treatment.   


Pts with poor PS treated with anti-PD-1 immunotherapy have worse survival compared to published clinical trial data. However, treatment appears well tolerated.  Further research is warranted in this patient population.