Opinion
Video
Impact of Performance Status on Treatment Selection for Patients with mNSCLC
Specialists address the intricate factors between comorbidities, efficacy, and tolerance, which influence their treatment approaches at the time of diagnosis.
Mark Socinski, MD: Martin, we have seen such a change in the practice of lung cancer [management], but in the population that we typically see with non–small cell lung cancer [NSCLC], the median age is about 70 or 71 [years]. The majority of patients have a smoking history. There are always issues [with] performance status [and] comorbidities at the time of diagnosis. And what are your thoughts around that? What do you see in your practice, these sorts of things? How do they factor into your decision-making?
Martin Dietrich, MD, PhD: Well, that’s an important assessment. In the beginning, [with] both of us practicing in Florida, the performance status in a geriatric assessment is a major factor in deciding the different chemotherapy regimens. We’ve seen some real-world data looking at chemotherapy in combination with immunotherapy and what seems to be beneficial in younger patients, [who are] defined as [those] 65 [years] or younger, and an increasing detriment as we’re moving into older patients. But age is obviously only one of the factors that we are taking into consideration: biological factors, comorbidities, functional performance status. [It] is a very refined decision. I’m not sure that we have clearly defined cutoffs, and what’s very clear is that for chemotherapy, we’re seeing a detriment as we’re moving into older [patients] and [those with poorer] performance status. For immunotherapy, it’s less a concern of toxicity but more a concern of reduced expectations of efficacy as patients have poor performance status, probably also reflecting a lesser strength of their immune system to amount to antitumor responses. So it’s a fine-tuning between the different opportunities in the nondriver setting to decide about chemotherapy and immunotherapy applications. The main concern for toxicities that we’re seeing in patients with preexisting autoimmune conditions [is that] about 20% of our patients have some degree of autoimmune conditions, and it is a question of risk and benefit in the individual and setting. Sometimes those may be mild dermatologic conditions that may be manageable while the patient is on immunotherapy, but there are certainly others where the quality-of-life impairment may be superseding the expected effect of immunotherapy. That’s where biomarkers make a big impact on me. That is to prognosticate, not only on a gray scale, how well would [I] expect tolerance to be but how well would I expect efficacy to be. So it’s a complicated first-visit assessment to learn about the patient and try to understand [how] we feel and the different treatment options.
Mark Socinski, MD: And the other variable, at least in my mind when I’m thinking about this, there might be a difference between chronological age and what the patient’s doing. But we also know that…if a patient has a high-grade toxicity, do they have the reserve to tolerate that and come back for the next cycle?
Transcript is AI generated and edited for clarity and readability.
