Nivolumab versus Best Supportive Care after failure of Chemotherapy in Non-Small Cell Lung Cancer Patients with ECOG 3 or 4: A Propensity Matched Analysis.

Introduction: Non small cell lung cancer (NSCLC) patients with poor Eastern Cooperative Oncology Group Performance Status (ECOG PS >2) represent a challenging subset of patients. Best supportive care (BSC) has been the standard of care as per NCCN guidelines in this cohort; however immune checkpoint inhibitors have a potential of offering better tolerance and survival benefits. This study aimed to compare outcomes of immunotherapy versus BSC in NSCLC patients with PS>2. Methods: This is a retrospective analysis of NSCLC patients who have progressed on initial lines of therapy and had ECOG PS 3 or 4. A propensity score matching was conducted between the two groups- those who received immune checkpoint inhibitors (nivolumab group) and those who were managed with BSC (BSC group) using the variables of age, sex, smoking status, stage and tumor type. The final study cohort included 39 patients in nivolumab arm and 21 in BSC arm. Baseline demographics, treatment responses, overall survival (OS), and adverse events were compared. Results: Most patients were males (81.7%), smokers (85%), and had stage IV disease (75%), and squamous histology (70%). PDL1 status was unknown in 53.3%. All patients had initially received platinum-based-doublet chemotherapy. Compared to the nivolumab group, the BSC group had a higher proportion of ECOG 4 patients (80.9% vs 35.9%, p2.