Prognostic features in NSCLC patients with ECOG-PS 2-4: A prospective cohort study

BackgroundPatients (pts) with metastatic NSCLC often present ECOG-PS 2+ at diagnosis. Identifying those pts with a life expectancy ≤ 90 d allows for early referral to palliative care and favors better adequacy of resources. This study aimed to characterize those factors associated with an overall survival (OS) < 90 d. (ClinicalTrials.gov: NCT04306094).MethodsIt is a prospective cohort study (Nov/17 – Jun/23). All eligible pts met the following criteria: ≥ 18 y.o.; treatment-naive, histologically proven NSCLC stages IVA-IVB; ECOG-PS 2-4; no other cancer, and were consecutively included after signing informed consent. We collected 83 baseline features, including, but not restricted to, demographics, histology, EGFR-mutational status, medical history, nutritional status and body composition, smoking status, symptom burden, palliative scores, and laboratory values. We defined cachexia as published by Fearon et al. (2011). Logistic regression (LR) was performed to adjust prognostic factors related to OS < 90 d. The Hosmer-Lemeshow test was conducted to assess the goodness of fit of the LR model.Results180 pts were included: median age was 67 y.o. (18-86), 58% were male, and 152 pts (84%) were current/previous smokers. In terms of ECOG-PS, 107 presented PS2 (59%), 57 PS3 (32%), and 16 PS4 (9%). Adenocarcinoma was the most common histology (61%, EGFR mut in 16 pts), followed by squamous histology (26%). CNS metastases were detected in 40 pts (22%) and liver involvement in 17 pts (9%). Median OS was 87 d, and 91 pts (51%) had OS < 90 d. According to ECOG-PS, mOS was 106 d (PS2), 55 d (PS3) and 24 d (PS4) (p<0.0001). The table below shows the LR results, adjusted for factors related to OS < 90 d. The Hosmer-Lemeshow test confirmed the goodness of fit of the LR model. Table: 1494P OR 95% CI p-value Hemoglobin (Hb) level 0.78 0.65 - 0.94 0.009 PAP score 1.40 1.14 - 1.72 0.001 Supplemental O2 requirements 7.08 1.86 - 26.99 0.004 Cachexia 3.24 1.14 - 9.27 0.027 ECOG PS 3-4 2.17 1.02 - 4.64 0.046 ConclusionsIn this cohort of pts, Hb level, PAP score, use of supplemental O2, presence of cachexia and ECOG-PS 3-4 were important determinants of OS < 90 d. Prognostic models incorporating these factors should be developed to improve OS estimation in these pts.Clinical trial identificationNCT04306094.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureG. De Castro Jr.: Financial Interests, Personal, Invited Speaker: Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Janssen, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer, Roche, TEVA, Lilly; Financial Interests, Personal, Advisory Board: Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Janssen, Libbs, Lilly, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer, Roche, TEVA, Yuhan, Sanofi; Financial Interests, Local PI: Amgen, AstraZeneca, Bristol Myers Squibb, GSK, Janssen, Merck Serono, Merck Sharp & Dohme, Novartis, Roche; Financial Interests, Steering Committee Member: AstraZeneca, Bayer, Beigene, Merck Sharp & Dohme; Financial Interests, Personal, Steering Committee Member: GSK, Novartis; Financial Interests, Institutional, Local PI: Lilly, Pfizer, Sanofi. All other authors have declared no conflicts of interest.