Early functional deterioration during first-line ICI-based therapy in advanced NSCLC: implications for supportive care.

In 30 seconds

This secondary exploratory analysis of prospectively collected data from a randomized pulmonary rehabilitation trial assessed early functional change in 42 people receiving first-line immune checkpoint inhibitor–based therapy for advanced NSCLC. At 8 weeks, 29/42 participants (69.0%) had deteriorated in at least one of three objective domains—quadriceps force, SPPB, or 6MWD—even though ECOG performance status remained stable. Deterioration rates varied across measures and agreement between them was low. The analysis found no significant adjusted baseline associations, and the numerically less favorable subsequent PFS among those with deterioration was not statistically significant.

Key findings

• At 8 weeks, 29/42 participants (69.0%) had deterioration in at least one functional domain despite stable ECOG performance status.
• Deterioration affected quadriceps force in 23 (54.8%), SPPB in 14 (33.3%), and 6MWD in 5 (11.9%).
• Deterioration frequencies differed across measures (Cochran's Q=16.76, p<0.001), with low pairwise agreement.
• Deterioration was associated with numerically less favorable subsequent PFS, but the association was not statistically significant.

Why it matters

Stable ECOG performance status may not capture early changes across distinct aspects of physical function during ICI-based therapy. The differing deterioration rates and low agreement between measures suggest that a single functional measure may miss emerging vulnerability. Objective, complementary assessments could therefore inform supportive-care evaluation, although this analysis does not establish that monitoring improves outcomes.

What to keep in mind

This was a secondary exploratory analysis with 42 participants assessed at baseline and 8 weeks; the reported PFS association was not statistically significant.