Abstract
Patients with poor Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 3 may be considered for systemic chemotherapy when the decline is driven by reversible tumour-related factors, but assessing reversibility is often difficult, and some patients ultimately receive best supportive care. We report the case of a 76-year-old man with extensive-stage small cell lung cancer (SCLC) whose condition declined to PS 3 due to obstructive jaundice from pancreatic metastasis and a painful femoral fracture. Biliary stenting improved hepatic function; however, after the first cycle of carboplatin and etoposide, the femur fractured completely, requiring bipolar hemiarthroplasty. Postoperatively, PS improved, enabling the continuation of chemotherapy with carboplatin, etoposide and atezolizumab. Imaging demonstrated regression consistent with partial response, and PS improved to 1. This case emphasises that repeated PS assessment and multidisciplinary management of reversible conditions, including obstructive jaundice and a pathological fracture, can facilitate systemic therapy in poor-PS SCLC.