Age is not prognostic
“I think it’s important though to remember that in this study there are very distinct populations of patients. Poor performance status and comorbidities are prognostic, but age is not,” Dr. Leighl said in her discussion.
“In terms of current standards, performance status 3 patients are currently recommended to have best supportive care unless a targeted therapy is available for them, and while PS 2 patients have been excluded from checkpoint inhibitor trials, we treat most of these patients the same way. In this study in particular, patients had to be ineligible for platinum doublet therapy, but of course this definition was subjective,” she said.
She also commented that “if we’re now going to treat everyone with atezolizumab, I think the budget impact of this is going to be huge.”
It will be important to identify more clearly those patients aged 80 and older who might benefit from atezolizumab in this setting by better incorporating biomarkers such as PD-L1 levels to determine who can benefit from therapy and who might be spared the necessity of coming into the hospital or clinic for regular intravenous infusions, she added.
The study was supported by F. Hoffman-La Roche. Dr. Lee disclosed research funding from the company to his institution. Dr. Leighl disclosed institutional grant funding and personal fees from Roche and others.