How safe is immune checkpoint inhibition in patients with advanced non-small cell lung cancer (NSCLC) who are medically-unfit for a platinum doublet chemotherapy due to advanced age and/or poor performance status? The phase 3 IPSOS trial enrolled 453 patients with stage IIIB (14%) or IV (86%) NSCLC and ECOG 2-3 or age >70 and unfit for platinum doublet and randomized them 1:1 to single agent physician’s choice chemo (vinorelbine or gemcitabine) versus single-agent atezolizumab. Of note, over half of patients had no PD-L1 expression. The primary endpoint of overall survival was significantly improved with atezo monotherapy from a median of 9 → 10 months and from 12 → 24% at 2 years. While this may not be jaw-dropping, atezo also came with fewer grade 3+ events (33 → 16%) and better quality of life. As a final note, we’ll ask what beyond indefinite systemic therapy is a safe and effective therapeutic option for these patients? Three weeks or less of radiation to dominant thoracic disease. | Lee, Lancet 2023
