Atezolizumab is an immune checkpoint inhibitor (ICI) used to treat advanced NSCLC. The prognostic value of patient-reported outcomes (PROs) has been minimally explored for emerging ICIs. The performance of PROs compared with Eastern Cooperative Oncology Group performance status (ECOG-PS) is unknown.
This study pooled data from trials IMPOWER130, IMPOWER131 and IMPOWER150. The association of pre-treatment PRO with overall survival (OS) and progression-free survival (PFS) were modelled using Cox proportional hazards regression. All analyses were stratified by study and treatment. Analyses adjusted for known prognostic variables were conducted. Prediction performance was assessed via the C-statistic (c). PROs were evaluated via the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire
The study included 1932 patients initiated on atezolizumab + chemotherapy for treatment naïve advanced NSCLC. Patient-reported physical function, fatigue, appetite loss were associated with OS and PFS on univariable and adjusted analysis (p<0.05). Physical function (c = 0.66), fatigue (c = 0.66), and appetite loss (c = 0.66) were the most predictive PROs for OS. The OS prediction performance of physical function (c = 0.59) was superior to ECOG-PS (c = 0.57), with multivariable analysis indicating both provide independent information (p<0.0001). Of the 761 participants with a clinician-assigned pre-treatment ECOG-PS of 0, 56% self-reported intermediate to low physical function – indicative that physicians should better consult patients on their troubles with activities of daily living, prior to categorising patients’ statuses as ‘no restrictions, perfect mobility’.
PROs were identified as independent prognostic factors for survival outcomes in advanced NSCLC patients initiating first-line atezolizumab combination therapies. Further, patient-reported physical function was more predictive than ECOG-PS and contained independent information. This highlights a potential value of PROs as a prognostic and stratification factor for clinical use and research trials of ICIs.