{"doi":"10.1136/jitc-2020-001007","title":"Outcomes to first-line pembrolizumab in patients with PD-L1-high (≥50%) non–small cell lung cancer and a poor performance status","abstract":"Background Patients with non–small cell lung cancer (NSCLC) and a poor Eastern Cooperative Oncology Group Performance Status (ECOG PS) have been excluded from phase III immunotherapy clinical trials. We sought to evaluate clinical outcomes to first-line pembrolizumab in patients with advanced NSCLC, a PD-L1 Tumor Proportion Score (TPS) of ≥50%, and an ECOG PS of 2. Methods We performed a multicenter retrospective analysis of patients with metastatic NSCLC and a PD-L1 TPS of ≥50% (negative for genomic alterations in EGFR and ALK ) who received treatment with first-line pembrolizumab. Clinical outcomes were compared in patients based on ECOG PS. Results Among the 234 patients, 83.3% (n=195) had an ECOG PS of 0 or 1, and 16.7% (n=39) had an ECOG PS of 2. The baseline clinicopathological characteristics were balanced between the ECOG PS 0–1 vs 2 groups in terms of age, sex, tobacco use, histology, KRAS mutation status, presence of other potentially targetable driver mutations ( BRAF, MET, HER2, RET ), presence of brain metastases, and PD-L1 TPS distribution. Compared with patients with an ECOG PS of 0 or 1, patients with an ECOG PS of 2 had a significantly lower objective response rate (43.1% vs 25.6%; p=0.04), a numerically shorter median progression-free survival (6.6 months vs 4.0 months; HR 0.70 (95% CI 0.47 to 1.06); p=0.09), and a significantly shorter median overall survival (20.3 months vs 7.4 months; HR 0.42 (95% CI 0.26 to 0.68); p<0.001). On disease progression, patients with an ECOG PS of 2 were significantly less likely to receive second-line systemic therapy compared with patients with an ECOG PS of 0–1 (65% vs 22.2%, p=0.001). Conclusions A subset of patients with NSCLC and an ECOG PS of 2 can respond to first-line pembrolizumab. However, clinical outcomes in this population are often poor and use of second-line systemic therapy is infrequent.","journal":"Journal for ImmunoTherapy of Cancer","year":2020,"id":65354,"datarank":0.6141516843333151,"base_score":4.0943445622221,"endowment":4.0943445622221,"self_citation_contribution":0.6141516843333151,"citation_network_contribution":0.0,"self_endowment_contribution":0.6141516843333151,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":59,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9188,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":243063,"name":"Biagio Ricciuti","orcid":"0000-0002-0651-2678","position":1,"is_corresponding":false},{"id":346647,"name":"E. Jimenez-Aguilar","orcid":null,"position":2,"is_corresponding":false},{"id":251016,"name":"Fangxin Hong","orcid":"0000-0001-8049-0086","position":3,"is_corresponding":false},{"id":345564,"name":"Zihan Wei","orcid":"0000-0001-9234-3497","position":4,"is_corresponding":false},{"id":243071,"name":"Mizuki Nishino","orcid":"0000-0003-0275-0502","position":5,"is_corresponding":false},{"id":269964,"name":"Andrew J. Plodkowski","orcid":"0000-0002-3772-370X","position":6,"is_corresponding":false},{"id":345565,"name":"Peter Sawan","orcid":"0000-0002-7757-899X","position":7,"is_corresponding":false},{"id":232518,"name":"Jia Luo","orcid":"0000-0003-3606-827X","position":8,"is_corresponding":false},{"id":91573,"name":"Hira Rizvi","orcid":"0000-0002-8007-096X","position":9,"is_corresponding":false},{"id":345566,"name":"Brett W. Carter","orcid":"0000-0002-3841-8352","position":10,"is_corresponding":false},{"id":227923,"name":"John V. Heymach","orcid":"0000-0001-9068-8942","position":11,"is_corresponding":false},{"id":236012,"name":"Mehmet Altan","orcid":"0000-0001-9229-156X","position":12,"is_corresponding":false},{"id":90691,"name":"Matthew D. Hellmann","orcid":"0000-0002-2670-9777","position":13,"is_corresponding":false},{"id":227614,"name":"Mark M. Awad","orcid":"0000-0003-0928-5244","position":14,"is_corresponding":false},{"id":345563,"name":"Joao V. Alessi","orcid":"0000-0002-8072-5946","position":0,"is_corresponding":true}],"reference_count":20,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T21:13:23.327603Z","pmid":"32753547","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}