Rapid Response to Pembrolizumab in a Critically Ill Mechanically Ventilated Patient with New Diagnosis of NSCLC

McLoughlin, Erin M.; Larner, James M.; Bergman, Michael P.; Stelow, Edward B.; Brady, Kevin Rep; Lynch, Alia C.; Abraham, Ralph; Gentzler, Ryan D.

doi:10.1016/j.jtho.2019.04.010

Cited by 8 publications

(4 citation statements)

References 6 publications

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“…Although there are no dedicated ongoing trials for PS 3-4 patients, Lazarus type responses to ICIs have still been observed in those patients with strong PD-L1 expression (≥50%), as was the case in the three patients in our report (29). Even in critically ill patients with mechanical ventilation, rapid and long-lasting responses have also been observed (30). Therefore, when it comes to the special population of patients with poor PS, the use of anti-PD-1/PD-L1 agents may be justified by virtue of their favorable toxicity profile and long-term efficacy.…”

Section: Discussionmentioning

confidence: 47%

“…A retrospective analysis of the use of ICIs in patients with various cancers (including colorectal, small bowel, gastric, biliary tract, pancreatic, and endometrial cancers) with a PS of 2 -3 (patients with a PS of 3 accounted for 26% of the cohort) showed an overall manageable safety profile (28). For NSCLC patients with a PS of 3-4, immunotherapy was still found to be safe, although only a few cases have been reported (29,30). In short, ICIs are generally well tolerated, and the side effects are manageable in most cases (15).…”

Section: Discussionmentioning

confidence: 99%

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Lazarus type response to immunotherapy in three patients with poor performance status and locally advanced NSCLC: a case series and literature review

Nie¹,

Liu²,

Mao³

et al. 2021

Ann Palliat Med

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Background: Immune checkpoint inhibitors (ICIs) have become the standard treatment for patients with advanced non-small cell lung cancer (NSCLC). However, the safety and efficacy of ICIs in severe advanced NSCLC patients with poor performance status (PS) are still unclear.Methods: In the current study, we report a retrospective case series of three critically ill NSCLC patients with poor PS treated with immunotherapy in our hospital, and discussed these cases with reference to the existing literature and guidelines.Results: Before treatment, the Eastern Cooperative Oncology Group (ECOG) PS scores of all three patients were 4, while programmed cell death protein ligand-1 (PD-L1) was strongly expressed (over 50%).After initiating anti-programmed cell death 1 (PD-1)/PD-L1 agents, the PS score of the three patients improved rapidly to 0-1 in a short time. A Lazarus type response was observed in all patients. There were no grade 3-4 immune-related adverse events (irAEs) in any of the patients, and only one patient developed rash (grade 2 irAE) and hypothyroidism (grade 2 irAE). The best response across all three patients was partial response (PR). As of the latest follow-up date on June 10, 2020, two patients are still alive, with the other having died on January 14, 2020, whose progression-free survival (PFS) and overall survival (OS) were 11 and 16 months, respectively. Conclusions: Immunotherapy is still an effective and low-toxicity option for severe advanced NSCLC patients with poor PS. Lazarus type response may occur, especially in patients whose PD-L1 is strongly expressed (≥50%). However, a greater amount of real-world data or randomized clinical trials are needed in this setting.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Lazarus type response to immunotherapy in three patients with poor performance status and locally advanced NSCLC: a case series and literature review

Nie¹,

Liu²,

Mao³

et al. 2021

Ann Palliat Med

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“…The “Lazarus response” was also anecdotally described in patients with a very poor PS (PS ≥ 3), who were treated with immunotherapy [ 64 , 65 ]. An initial PS ≥ 3 improved to 0 after only one month of ICI-based therapy, with a follow-up after more than 24 months and a major tumor response.…”

Section: Io In Poor Performance Status (Ps) Patientsmentioning

confidence: 99%

Immune Checkpoint Inhibitors in “Special” NSCLC Populations: A Viable Approach?

Bronte

Cosi

Magri

et al. 2023

IJMS

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Over the last decade, the therapeutic scenario for advanced non-small-cell lung cancer (NSCLC) has undergone a major paradigm shift. Immune checkpoint inhibitors (ICIs) have shown a meaningful clinical and survival improvement in different settings of the disease. However, the real benefit of this therapeutic approach remains controversial in selected NSCLC subsets, such as those of the elderly with active brain metastases or oncogene-addicted mutations. This is mainly due to the exclusion or underrepresentation of these patient subpopulations in most pivotal phase III studies; this precludes the generalization of ICI efficacy in this context. Moreover, no predictive biomarkers of ICI response exist that can help with patient selection for this therapeutic approach. Here, we critically summarize the current state of ICI efficacy in the most common “special” NSCLC subpopulations.

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“…These patients improved from PS ≥3 before immunotherapy initiation to PS 0 after only one-month anti-PD-1 treatment with a follow-up currently exceeding 24 months and major tumor shrinkage. Recently, other trials have similarly suggested that pembrolizumab could be considered in critically ill NSCLC patients with a PD-L1 expression of 50% or more [10].…”

Section: Poor Performance Status Patientsmentioning

confidence: 99%

Ongoing challenges of using immunotherapy in special populations: Poor performance status patients, elderly patients, and people living with HIV

2020

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Rapid Response to Pembrolizumab in a Critically Ill Mechanically Ventilated Patient with New Diagnosis of NSCLC

Cited by 8 publications

References 6 publications

Lazarus type response to immunotherapy in three patients with poor performance status and locally advanced NSCLC: a case series and literature review

Lazarus type response to immunotherapy in three patients with poor performance status and locally advanced NSCLC: a case series and literature review

Immune Checkpoint Inhibitors in “Special” NSCLC Populations: A Viable Approach?

Ongoing challenges of using immunotherapy in special populations: Poor performance status patients, elderly patients, and people living with HIV

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