The Role of Performance Status in Small-Cell Lung Cancer in the Era of Immune Checkpoint Inhibitors

Alex Friedlaender, Stephen V. Liu, Antonio Passaro, Giulio Metro, Giuseppe Banna, Alfredo Addeo

Research output: Contribution to journalComment/debatepeer-review


After decades of platinum-based chemotherapy for advanced small-cell lung cancer, there has finally been a therapeutic advance. The combination of a platinum chemotherapy, etoposide, and an immune checkpoint inhibitor has yielded overall survival benefits in two successive phase 3 trials. Unfortunately, these trials only included fit patients, namely those with an Eastern Cooperative Oncology Group performance status of 0-1. In the real-world setting, roughly a third of patients with advanced small-cell lung cancer has a performance status of 2, and an additional 15% have a performance status of 3 or 4, meaning that approximately half of all patients are excluded from chemoimmunotherapy trials. Poor performance status is a known negative prognostic factor, with a dismal prognosis among patients with disease that does not respond to the first cycle of chemotherapy.We review current data on immunotherapy in advanced small-cell lung cancer and discuss how we integrate the new therapeutic options into daily practice.

Original languageEnglish
Pages (from-to)e539-e543
JournalClinical Lung Cancer
Issue number6
Publication statusPublished - Nov 2020


  • Chemoimmunotherapy
  • Immunotherapy
  • Performance status
  • PS2
  • SCLC

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research


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