Cancer patients with ECOG-PS higher than 1: Who are those who benefit of palliative chemotherapy?

Autor: Bruno Mendonça Protásio, Rafael Caires-Lima, Julia Andrade De Oliveira, Milena Perez Mak, Paulo M. Hoff, Lucila Soares da Silva Rocha, Inacelli Queiroz de Souza Caires, Raquel Bezerra Guerra, Gilberto de Castro
Rok vydání: 2013
Předmět:
Zdroj: Journal of Clinical Oncology. 31:9561-9561
ISSN: 1527-7755
0732-183X
DOI: 10.1200/jco.2013.31.15_suppl.9561
Popis: 9561 Background: Palliative chemotherapy (PC) is a treatment option in pts with metastatic cancer. Although pts with ECOG-PS > 1 are underrepresented in clinical trials, they are often treated with PC in daily practice. We aimed to identify factors associated with poorer survival and lack of benefit of PC in this subset of pts. Methods: We conducted a case-control retrospective analysis of 301 consecutive pts with solid tumors and ECOG-PS > 1 when initiated PC, selected from 2514 pts who died between Aug/2011 and Jul/2012 in a tertiary cancer care institution or its hospice. Cases were defined as those pts who survived < 90d after the first cycle of first line PC, and controls were those who had a longer survival. Frequencies were compared by chi-square test or Fisher exact test. Risks were estimated by odds ratios (OR) and logistic regression analysis. Overall survival (OS) was calculated by Kaplan-Meier method and curves was compared using log-rank test. Results: 142 cases/159 controls were included: median age 58/63 y.o. (p=0.09; t-test) and 49%/50% female (p=0.941; chi-square). Gastrointestinal and lung cancers were the most frequent primaries (31 and 17%, respectively). Factors associated with poorer OS were age > 60 y.o. (OR 1.7; 95%CI 1.0–2.6), ECOG-PS > 2 (1.9; 1.2–3.1), weight loss > 10% (1.8; 1.1-2.8), hemoglobin < 10 g/dL (2.6; 1.6-4.2), albumin < 3 g/dL (2.7; 1.5-5.1), serum creatinine (sCr) > 1 mg/dL (2.8; 1.6-5.0), C-reactive protein ≥ 5 mg/L (8.6; 1.0-72.9), altered mental status (4.2; 1.4-13.2) and in-hospital PC (3.2; 1.9-5.2). Cases were more likely to experience grade ≥ 3 toxicity (43 vs. 28%; p=0.005), die of toxicity (16 vs. 6%; p = 0.0007) and not be offered palliative care only (47 vs. 71%; p 2 (OR 2.3, p=0.044) and sCr > 1 mg/dL (OR 11.2, p=0.0002) as independent predictors of 3-mo fatality. Conclusions: ECOG-PS > 2 and elevated sCr were identified as independent predictors of poor OS in these pts. PC needs to be prescribed with caution in ECOG-PS > 1 pts, since it seems to offer no benefit in OS and could lead to abbreviation of life.
Databáze: OpenAIRE
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