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PS2 Immunotherapy — SCE Medical Oncology MCQ

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ModerateLung CancerPS2 ImmunotherapySCE Medical Oncology

A 68-year-old man with advanced NSCLC has an ECOG PS of 2. His oncologist discusses the reduced benefit and increased toxicity of immunotherapy in PS 2 patients. What trial data informs this concern?

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Correct answer: B — Most landmark immunotherapy trials (KEYNOTE-024, KEYNOTE-189, CheckMate 227) excluded ECOG PS 2 patients — real-world data shows lower efficacy and higher toxicity in PS 2

ECOG PS 2 patients were excluded from most pivotal ICI lung cancer trials (KEYNOTE-024/189, CheckMate 227). Real-world studies show lower response rates and shorter OS in PS 2 patients on ICI compared with PS 0-1. The PePS2 trial specifically evaluated pembrolizumab in PS 2 NSCLC patients — showing some activity but higher treatment-related toxicity and shorter survival. Careful patient selection, shared decision-making and consideration of reduced-intensity approaches are essential.

Reference: ESMO 2024 NSCLC Guidelines; PePS2 Middleton et al Lancet Respir Med 2020