Evidence date · 2021-01-01 · Research note 1 of 2
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In a 2021 report, three people with advanced non-small cell lung cancer (NSCLC) began immunotherapy while critically ill and at the most severe end of a daily-function scale. Their function improved rapidly after treatment. The cases are striking because the change was large; they leave open how often it happens and what produced it.
A dramatic shift in daily function
Before treatment, all three patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 4. This scale describes how much illness limits a person’s ability to function. A score of 4 is its most severe level; scores of 0–1 indicate much better function, with little or limited restriction.
After receiving drugs directed at PD-1 or PD-L1, immune checkpoint proteins involved in how immune responses are regulated, each patient’s reported score improved rapidly to 0–1. The authors called this a “Lazarus type response,” a description of a dramatic reversal in function. It names what they observed; it is not evidence that such a change is predictable.
All three patients also had PD-L1 expression above 50% before treatment. That shared feature is useful context for the cases, but three observations cannot show whether the level helped predict their improvement or whether another patient with the same result would respond similarly.
Better function was not the same as tumor response
The improvement in performance status describes how the patients were functioning. The tumor assessment was a separate measure: the best response reported across the three cases was a partial response (PR), a category indicating that tumors shrank without disappearing completely. The report does not describe these outcomes as complete tumor responses.
The follow-up details also show that the patients did not all have the same course. As of June 10, 2020, two were alive. The third had died on January 14, 2020; the paper reported progression-free survival of 11 months and overall survival of 16 months for that patient. These dates and outcomes belong to the report’s follow-up, not to a shared survival result for all three.
What three cases can say about harms
No grade 3–4 immune-related adverse events were observed in the series. One patient experienced a grade 2 rash and hypothyroidism. These are the harms recorded among these three people, not a reliable estimate of how often severe or milder side effects occur in a larger group.
The study was a retrospective case series: it describes three patients who received treatment, rather than comparing treatment choices in a controlled trial. It can document an unusual clinical pattern and raise a question for further study, but it cannot establish that immunotherapy caused the functional gains, estimate how frequently they occur, or show that high PD-L1 predicts a “Lazarus” response. The same small number of cases also makes the absence of severe events uninformative as a broader safety rate.
What this could mean for patients with very poor function
For patients with advanced lung cancer whose daily function is extremely limited, treatment decisions can be especially difficult. If larger studies confirm meaningful benefit with acceptable harms, clinicians could have stronger evidence for considering immune checkpoint treatment in some patients in this situation. This three-person report raises that possibility; it does not establish a treatment recommendation.
Key Sources
- Primary source: Lazarus type response to immunotherapy in three patients with poor performance status and locally advanced NSCLC: a case series and literature review.
DOI or Journal Page · Review or Meta-Analysis · 2021-01-01