Table 1.
Expert panel statements on the use of first-line immunotherapy in A-NSCLC patients with PS 2
| Panel questions | Expert conclusions |
|---|---|
| PS 2 assessment | |
| Q1. Is ECOG PS scale still adequate for clinical condition assessment in the immunotherapy era? | At all panelists, ECOG PS scale is considered not adequate and needs subclassifications according to the determinants of PS impairment (tumor-related versus comorbidities). |
| Q2. In A-NSCLC patients with PS 2 does the determinant of poor PS (tumor-related or comorbidity) affect your treatment choice? | Yes, with particular concern regarding chemotherapy agents rather than immunotherapy per se. |
| Single-agent immunotherapy | |
| Q3. In A-NSCLC patients with PS 2 and PD-L1 ≥50% is single-agent immunotherapy feasible and safe? | Yes, based on data available from real life only, to date in the absence of prospective phase III trials including PS 2 patients. |
| Q4. In A-NSCLC patients with PS 2 and PD-L1 ≥50% is single-agent immunotherapy effective? | Probably yes, based on data available from real life only, to date in the absence of prospective phase III trials including PS 2 patients. However, PS 2 is a strong negative prognostic factor and results are, as with any treatment, inferior compared to PS 0-1 patients. |
| Combined chemotherapy and immunotherapy | |
| Q5. In A-NSCLC patients with squamous histology and PS 2 is combined chemotherapy plus single-agent immunotherapy feasible and safe? | Probably no, unless further data supporting safety become available. Based on data available from real life only, to date in the absence of prospective phase III trials including PS 2 patients, concerns are mainly related to platinum-based doublet tolerability. |
| Q6. In A-NSCLC patients with squamous histology and PS 2 is combined chemotherapy plus single-agent immunotherapy effective? | Probably yes, based on data available from real life only, to date in the absence of prospective phase III trials including PS 2 patients. |
| Q7. In A-NSCLC patients with non-squamous histology and PS 2 is combined chemotherapy plus single-agent immunotherapy feasible and safe? | Probably no, unless further data supporting safety become available. Based on data available from real life only, to date in the absence of prospective phase III trials including PS 2 patients, concerns are mainly related to platinum-based doublet tolerability. However, pemetrexed-based doublets are generally better tolerated as compared to chemotherapy regimens used in squamous histology. |
| Q8. In A-NSCLC patients with non-squamous histology and PS 2 is combined chemotherapy plus single-agent immunotherapy effective? | Probably yes, based on data available from real life only, to date in the absence of prospective phase III trials including PS 2 patients. |
| Q9. In A-NSCLC patients with PS 2 is combined chemotherapy plus double immunotherapy feasible and safe? | Probably no, unless further data supporting safety become available. Based on data available from real life only, to date in the absence of prospective phase III trials including PS 2 patients, concerns are mainly related to additional toxicity from anti-CTLA-4. |
| Q10. In A-NSCLC patients with PS 2 is combined chemotherapy plus double immunotherapy effective? | Probably yes, to date in the absence of prospective phase III trials including PS 2 patients. |
| Preferred treatments | |
| Q11. In A-NSCLC patients with PS 2 and PD-L1 ≥50%, does the PD-L1 value affect your choice between single-agent immunotherapy and combined chemo–immunotherapy? | No |
A-NSCLC, advanced non-small-cell lung cancer; CTLA-4, cytotoxic T-lymphocyte-associated antigen 4; ECOG, Eastern Cooperative Oncology Group; PD-L1, programmed death-ligand 1; PS, performance status; Q, question.