Impact of age on toxicity and efficacy of 5-FU-based combination chemotherapy among patients with metastatic colorectal cancer; a pooled analysis of five randomized trials

A Randomized Phase III Study of Arfolitixorin versus Leucovorin with 5-Fluorouracil, Oxaliplatin, and Bevacizumab for First-Line Treatment of Metastatic Colorectal Cancer: The AGENT Trial

PURPOSE

Suboptimal treatment outcomes with 5-fluorouracil (5-FU)/folate, the standard of care for metastatic colorectal cancer (mCRC), have generated interest in optimizing the folate. Arfolitixorin ([6R]-5,10-methylene-tetrahydrofolate) is an immediately active folate and may improve outcomes over the existing standard of care (leucovorin).

EXPERIMENTAL DESIGN

AGENT was a randomized, phase III study (NCT03750786). Patients with mCRC were randomized to arfolitixorin (120 mg/m2 given as two intravenous bolus doses of 60 mg/m2) or leucovorin (400 mg/m2 given as a single intravenous infusion) plus 5-FU, oxaliplatin, and bevacizumab. Assessments were performed every 8 weeks. The primary endpoint was the superiority of arfolitixorin for overall response rate (ORR).

RESULTS

Between February 2019 and April 2021, 490 patients were randomized (245 to each arm). After a median follow-up of 266 days, the primary endpoint of superiority for ORR was not achieved (48.2% for arfolitixorin vs. 49.4% for leucovorin, Psuperiority = 0.57). Outcomes were not achieved for median progression-free survival (PFS; 12.8 and 11.6 months, P = 0.38), median duration of response (12.2 and 12.9 months, P = 0.40), and median overall survival (23.8 and 28.0 months, P = 0.78). The proportion of patients with an adverse event of grade ≥3 severity was similar between arms (68.7% and 67.2%, respectively), as was quality of life. BRAF mutations and MTHFD2 expression were both associated with a lower PFS with arfolitixorin.

CONCLUSIONS

The study failed to demonstrate clinical benefit of arfolitixorin (120 mg/m2) over leucovorin. However, it provides some useful insights from the first-line treatment setting, including the effect of gene expression on outcomes.

SIGNIFICANCE

This phase III study compared arfolitixorin, a direct-acting folate, with leucovorin in FOLFOX plus bevacizumab in mCRC. Arfolitixorin (120 mg/m2) did not improve the ORR, potentially indicating a suboptimal dose.

The Impact of Omitting 5-FU Bolus From mFOLFOX6 Chemotherapy Regimen on Hematological Adverse Events Among Patients With Metastatic Colorectal Cancer

Background

Metastatic colorectal cancer (mCRC) is often treated with a mFOLFOX6 regimen. The 5-fluorouracil (5-FU) bolus is often omitted from the regimen to reduce the risk of hematological adverse events (AEs) in patients with poor performance status. We aimed to investigate the incidence of hematological AEs in Asian patients with mCRC who were treated with the mFOLFOX6 with and without 5-FU bolus dosing.

Methods

This retrospective chart review was conducted at King Chulalongkorn Memorial Hospital, Thailand from June 2021 to June 2022. The primary endpoints were hematological AEs. Secondary endpoints were any AEs. The comparison of continuous data was conducted with an independent t-test. The Chi-squared test was used to compare categorical data.

Results

From 110 patients, we found that hematological and non-hematological AEs of any grade in the two groups were not significantly different. However, patients in the bolus arm had a significantly lower absolute neutrophil count (ANC) than those in the non-bolus arm (mean difference = 43.13 (95% confidence interval (CI): 20.74, 65.51), P-value = 0.0002). A subgroup analysis in patients who received first-line treatment with mFOLFOX6 showed that the bolus arm had a significantly lower ANC (mean difference = 46.01 (95% CI: 19.99, 72.03), P-value = 0.0007).

Conclusions

mCRC patients who were treated with bolus 5-FU had lower ANC. The 5-FU bolus omission from the mFOLFOX6 regimen may be required in patients with a high risk of neutropenia.

Differences in prognosis and underuse of adjuvant chemotherapy between elderly and non-elderly patients in stage III colorectal cancer

Aim

We aimed to clarify the use of adjuvant chemotherapy and the prognosis of elderly colorectal cancer patients compared with non-elderly patients, and the usefulness of sarcopenia as an indicator for the introduction and completion of adjuvant chemotherapy.

Methods

Between 2013 and 2021, 215 patients with pStage III disease were included. We investigated perioperative clinicopathological factors, adjuvant chemotherapy details, and prognosis. Preoperative sarcopenia status was evaluated using computed tomography images. Elderly patients were defined as those aged ≥70 years.

Results

We included 121 (56.3%) and 94 (43.7%) non-elderly and elderly patients, respectively. Among the elderly patients, 47 had sarcopenia. There were no significant differences in the incompletion rate of adjuvant chemotherapy between elderly and non-elderly patients (27.1%/16.2%, P = 0.119). The most common reason for the discontinuation of adjuvant chemotherapy was side effects, regardless of age. The respective 3-year-disease free survival of patients with no/completed/incomplete adjuvant chemotherapy were 65.5%, 80.2%, and 57.7% for non-elderly patients (P = 0.045) and 73.4%, 70.6%, and 71.6% for elderly patients (P = 0.924). The number of elderly patients with sarcopenia was significantly higher in patients without adjuvant chemotherapy (P = 0.004) and those with incomplete adjuvant chemotherapy (P = 0.004). The 3-year-disease free survival of elderly sarcopenic patients without and with adjuvant chemotherapy were 78.3% and 59.2%, respectively (P = 0.833).

Conclusion

Elderly patients did not show a benefit of adjuvant chemotherapy regardless of whether they had completed adjuvant chemotherapy, unlike non-elderly patients. Moreover, the evaluation of preoperative sarcopenia in elderly colorectal cancer patients may be useful in determining the indication for adjuvant chemotherapy.

A real-world, population-based study for the outcomes of patients with metastatic colorectal cancer to the liver with distant lymph node metastases treated with metastasectomy

Aim: To assess the impact of metastasectomy on survival outcomes of patients with concurrent liver and distant nodal metastases. Materials & methods: Surveillance, Epidemiology, and End Results (SEER) database was accessed and patients with colorectal liver metastases (with or without distant lymph node involvement) were reviewed. Kaplan-Meier survival estimates were then used to assess the impact of the presence of distant lymph node metastases as well as the impact of metastasectomy on overall and cancer-specific survival. A propensity score matching was then conducted between patients with distant lymph node metastases who had surgery versus those who did not have surgery. Results: A total of 15,325 patients were included in the current analysis including 1603 patients who have liver and distant nodal metastases (10.5%) and 13,722 patients who have liver metastases only (89.5%). The following factors were associated with better overall survival (OS): younger age (hazard ratio [HR] with increasing age: 1.024; 95% CI: 1.022-1.025), white race (HR for African-American race vs white race: 1.233; 95% CI: 1.175-1.295), distal site of the primary (HR: 0.808; 95% CI: 0.778-0.840), absence of distant lymph nodes (HR: 0.697; 95% CI: 0.659-0.737), metastasectomy (HR for no metastasectomy vs metastasectomy: 1.954; 95% CI: 1.858-2.056). Within the postpropensity cohort, metastasectomy was associated with improved OS among patients with concurrent distant lymph node and liver metastases (median OS of 20 vs 11 months; p < 0.001). Conclusion: Metastasectomy seems to be associated with improved survival among patients with concurrent lymph node and liver metastases. It is unclear if improved survival is related to the surgical intervention or to the fact that surgically treated patients have a better baseline general condition and hence improved outcomes.

Coptidis Rhizoma Extract Reverses 5-Fluorouracil Resistance in HCT116 Human Colorectal Cancer Cells via Modulation of Thymidylate Synthase

Colorectal cancer (CRC) is a malignancy of the colon or rectum. It is ranked as the third most common cancer in both men and women worldwide. Early resection permitted by early detection is the best treatment, and chemotherapy is another main treatment, particularly for patients with advanced CRC. A well-known thymidylate synthase (TS) inhibitor, 5-fluorouracil (5-FU), is frequently prescribed to CRC patients; however, drug resistance is a critical limitation of its clinical application. Based on the hypothesis that Coptidis Rhizoma extract (CRE) can abolish this 5-FU resistance, we explored the efficacy and underlying mechanisms of CRE in 5-FU-resistant (HCT116/R) and parental HCT116 (HCT116/WT) cells. Compared to treatment with 5-FU alone, combination treatment with CRE and 5-FU drastically reduced the viability of HCT116/R cells. The cell cycle distribution assay showed significant induction of the G0/G1 phase arrest by co-treatment with CRE and 5-FU. In addition, the combination of CRE and 5-FU notably suppressed the activity of TS, which was overexpressed in HCT116/R cells, as compared to HCT116/WT cells. Our findings support the potential of CRE as an adjuvant agent against 5-FU-resistant colorectal cancers and indicate that the underlying mechanisms might involve inhibition of TS expression.

Individualized Dosing of Fluoropyrimidine-Based Chemotherapy to Prevent Severe Fluoropyrimidine-Related Toxicity: What Are the Options?

Fluoropyrimidines are widely used in the treatment of several types of solid tumors. Although most often well tolerated, severe toxicity is encountered in ~ 20-30% of the patients. Individualized dosing for these patients can reduce the incidence of severe fluoropyrimidine-related toxicity. However, no consensus has been achieved on which dosing strategy is preferred. The most established strategy for individualized dosing of fluoropyrimidines is upfront genotyping of the DPYD gene. Prospective research has shown that DPYD-guided dose-individualization significantly reduces the incidence of severe toxicity and can be easily applied in routine daily practice. Furthermore, the measurement of the dihydropyrimidine dehydrogenase (DPD) enzyme activity has shown to accurately detect patients with a DPD deficiency. Yet, because this assay is time-consuming and expensive, it is not widely implemented in routine clinical care. Other methods include the measurement of pretreatment endogenous serum uracil concentrations, the uracil/dihydrouracil-ratio, and the 5-fluorouracil (5-FU) degradation rate. These methods have shown mixed results. Next to these methods to detect DPD deficiency, pharmacokinetically guided follow-up of 5-FU could potentially be used as an addition to dosing strategies to further improve the safety of fluoropyrimidines. Furthermore, baseline characteristics, such as sex, age, body composition, and renal function have shown to have a relationship with the development of severe toxicity. Therefore, these baseline characteristics should be considered as a dose-individualization strategy. We present an overview of the current dose-individualization strategies and provide perspectives for a future multiparametric approach.

Real-world patterns of chemotherapy administration and attrition among patients with metastatic colorectal cancer

OBJECTIVE

To assess the real-world patterns of systemic treatment attrition rates among patients with metastatic colorectal cancer.

METHODS

Databases based from the provincial cancer registry and electronic medical records in Alberta were accessed, and cases with a de novo diagnosis of metastatic colorectal cancer with no history of other primary cancers (2004-2017) were reviewed. Rates of chemotherapy administration in first and subsequent lines of treatment were assessed. Multivariable logistic regression analysis for factors associated with non-administration of chemotherapy was evaluated. The impact of administration of all three chemotherapy agents (fluoropyrimidines, oxaliplatin, and irinotecan) across the course of treatment was assessed through multivariable Cox regression analysis with time-dependent covariates.

RESULTS

A total of 4179 patients with metastatic colorectal cancer were included in the current study. This includes 1988 patients receiving at least one cycle of chemotherapy and 2191 patients who did not receive any chemotherapy. The following factors were associated with a higher probability of no chemotherapy use: older age (OR 1.064; 95% CI 1.057-1.070), higher Charlson comorbidity index (OR 1.444; 95% CI 1.342-1.554), female sex (OR for male sex versus female sex 0.763; 95% CI 0.660-0.881), rural residence (OR for residence in zone 2 (Calgary) versus zone 5 (North zone) 0.346; 95% CI 0.272-0.440), proximal tumor location (OR 1.255; 95% CI 1.083-1.454), and earlier year at diagnosis (OR (continuous) 0.895; 95% CI 0.879-0.911). Within the cohort of patients who received at least one cycle of chemotherapy, 42.5% received one line of chemotherapy only, and 30.5% received two lines of chemotherapy. The use of all three chemotherapy drugs was associated with better overall survival (HR 3.305; 95% CI 2.755-3.965) and colorectal cancer-specific survival (HR 3.367; 95% CI 2.753-4.117).

CONCLUSIONS

A considerable proportion of metastatic colorectal cancer patients who received active chemotherapy in this population-based study received only one line of therapy. This highlights the significance of choosing effective treatments in the first-line treatment as the attrition rate is high. Furthermore, the use of all three chemotherapy agents across the course of treatment was associated with better outcomes.

Patient-Reported Cognitive and Functional Impairments Among Older Canadians With Cancer: a Population-Based Study

CONTEXT

Cancer is estimated to affect one out of two Canadians throughout their lifetime and to be the cause of death of one out of four Canadians. Although it can affect virtually patients of any age, it disproportionately affects older adults.

OBJECTIVES

The objective of the present study is to assess the prevalence of self-reported cognitive and functional impairments among older adults with cancer vs. older adults without cancer; and to evaluate the factors associated with self-reported cognitive impairment among older adults with cancer.

METHODS

Canadian Community Health Survey data sets (2007-2016) were accessed, and participants 65 years wand older who answered the question Do you have cancer? and who have complete information about participant-reported cognitive function (assessed through health utilities index) were included. Differences in participant-reported functional status (including cognition, vision, hearing, speech, ambulation, dexterity, and emotion) between older adults with or without cancer were evaluated through Chi-squared testing. Multivariable logistic regression analysis was conducted to assess factors associated with participant-reported cognitive impairment among older adults with cancer.

RESULTS

A total of 73,110 participants 65 years and older were included: 4342 participants with an active cancer diagnosis and 68,768 participants without an active cancer diagnosis (at the time of survey completion). Participants with cancer were more likely to report impairment in cognition (participants with cancer who can remember and think: 62.3%, whereas participants without cancer who can remember and think: 67.3%; P < 0.001), hearing (participants with cancer who can hear well: 82.2%, whereas participants without cancer who can hear well: 86.7%; P < 0.001), and mobility (participants with cancer who can walk without difficulty: 77.3%, whereas participants without cancer who can walk without difficulty: 84%; P < 0.001). The following factors were associated with participant-reported cognitive impairment among older adults with cancer: older age (odds ratio [OR] for age 65-69 years vs. age 80 years and older: 0.54; 95% CI: 0.35-0.84), lower income (OR: 2.12; 95% CI: 1.14-3.92), poor self-perceived health (OR for excellent vs. poor health: 0.38; 95% CI: 0.17-0.81), poor self-perceived mental health (OR for excellent vs. poor health: 0.08; 95% CI: 0.02-0.28), and illicit drug use (OR: 2.04; 95% CI: 1.31-3.18).

CONCLUSION

Older adults with an active cancer diagnosis are more likely to report impaired cognitive and functional status compared with older adults without an active cancer diagnosis. More efforts are needed to ensure the integration of validated geriatric assessment tools (incorporating patient-reported elements) in the care of older adults with cancer.

A Real-World, Population-Based Analysis of the Outcomes of Colorectal Cancer Patients with Isolated Synchronous Liver or Lung Metastases Treated with Metastasectomy

OBJECTIVE

To assess the survival outcomes among a contemporary cohort of colorectal cancer patients with isolated synchronous liver or lung metastases treated with or without surgical resection of the metastases.

METHODS

Surveillance, epidemiology and end results database has been accessed and cases with isolated liver or lung metastases diagnosed 2010-2015 have been accessed. Kaplan-Meier survival estimates were used to compare overall survival among patients who had or had not undergone metastasectomy. Multivariable Cox regression analysis was then used to assess the impact of metastasectomy on colorectal cancer-specific survival.

RESULTS

A total of 16,372 patients with colorectal cancer with isolated liver or lung metastases (M1a disease) were included in the current analysis (including 14,832 patients with isolated liver metastases and 1540 patients with isolated lung metastases). Patients who had undergone surgical resection of liver metastases have better overall survival compared to patients who had not undergone surgical resection of liver metastases (median overall survival: 38.0 months vs. 13.0 months; P < 0.001). Likewise, patients who had undergone surgical resection of lung metastases have better overall survival compared to patients who had not undergone surgical resection of lung metastases (median overall survival: 45.0 months vs. 19.0 months; P < 0.001). In a multivariable Cox regression analysis and among patients with isolated liver metastases, surgery to the metastases was associated with a reduced hazard of death (hazard ratio (HR) 0.567; 95% CI 0.529-0.609; P < 0.001). Likewise, and among patients with isolated lung metastases, surgery to the metastases was associated with a reduced hazard of death (HR 0.482; 95% CI 0.349-0.665; P < 0.001).

CONCLUSION

In a contemporary cohort, metastasectomy seems to be associated with improvement in overall and cancer-specific survival among patients with isolated synchronous liver or lung metastases from colorectal cancer. Whether this survival difference is totally ascribed to the effect of metastasectomy or it is the fact that patients who were eligible for surgical resection have limited disease extent and better medical profile (thus, leading to better survival) is unclear from such a population-based study.

Hospitalizations among early-stage colon cancer patients receiving adjuvant chemotherapy: a real-world study

OBJECTIVE

To assess the patterns of hospitalizations among early-stage colon cancer patients receiving adjuvant chemotherapy and to identify high-risk groups that may benefit from more careful monitoring in a real-world, population-based context.

METHODS

This is a population-based study using linked administrative databases from the province of Alberta, Canada. Any events of hospitalization among patients with non-metastatic colon cancer undergoing upfront surgery followed by adjuvant chemotherapy were reviewed. Multivariable logistic regression analysis was used to examine factors associated with risk of hospitalization, and the impact of hospitalization on overall survival was assessed through Kaplan-Meier estimates and Multivariable Cox regression analysis.

RESULTS

A total of 2257 patients were considered eligible and were included in the current analysis, including 483 patients (21.4%) who were hospitalized within 6 months of the start of adjuvant chemotherapy, and 1774 patients (78.6%) who were not. The following factors were associated with a higher hospitalization risk: older age (OR: 1.02; 95% CI 1.01-1.03), higher comorbidity (OR: 1.48; 95% CI 1.31-1.67), women (OR for men versus women: 0.79; 95% CI 0.64-0.98), living in the North zone (OR for Edmonton zone versus North zone: 0.60; 95% CI 0.42-0.87), and CAPOX chemotherapy (OR for CAPOX versus FOLFOX: 1.50; 95% CI 1.12-2.00). Patients with a history of hospitalization during adjuvant chemotherapy had a worse overall survival compared to patients who were not hospitalized (P < 0.001).

CONCLUSION

In this study, one out of five colon cancer patients were hospitalized during adjuvant chemotherapy. Older individuals, women, those with higher comorbidity, and those receiving adjuvant CAPOX were more likely to be hospitalized.

Combination Treatment With Paclitaxel, Carboplatin, and Cetuximab (PCE) as First-Line Treatment in Patients With Recurrent and/or Metastatic Nasopharyngeal Carcinoma

Background: Platinum-containing doublet chemotherapy regimens are generally considered the standard first-line systemic therapy for recurrent or metastatic (R/M) nasopharyngeal cancer (NPC). Gemcitabine (GEM) plus cisplatin (CDDP) has become a standard therapy based on a phase 3 study in several countries, yet this regimen sometimes affects quality of life due to nausea or appetite loss. Here, we present the manageable toxicity and promising activity of paclitaxel + carboplatin + cetuximab (PCE) therapy for R/M NPC. Materials and Methods: We conducted a retrospective review of patients with R/M NPC who were treated with PCE from 2013 to 2019 at the National Cancer Center East, Kashiwa, Japan. PCE consisted of PTX 100 mg/m2 on days 1 and 8; CBDCA area under the blood concentration-time curve (AUC) 2.5 on days 1 and 8, repeated every 3 weeks; and cetuximab at an initial dose of 400 mg/m2, followed by 250 mg/m2 weekly, as reported in the paper. Results: Fourteen patients were identified, consisting of 10 males and 4 females with a median age 59.6 years (range, 43-74). Among the 12 of 14 patients assessed for efficacy, overall response rate was 58.3%, with 2 complete responses and 5 partial responses. On median follow-up of 23.8 months, median overall survival was not reached with observed death events of 2. Median PFS was 4.1 months (95% CI, 2.6-5.6 months). Two patients experienced disease progression during cetuximab maintenance and restarted PCE treatment, then achieved partial response again. The most common grade 3 or 4 adverse events were neutropenia (21.4%) and skin reaction (14.3%). No treatment-related death was observed. Conclusion: Although the number of study population was small, our results suggest that PCE is feasible and potentially effective for R/M NPC, with a 58.3% response rate and 4.1-month PFS. Further prospective evaluation is warranted.

A 10-year review of survival among patients with metastatic gastrointestinal cancers: a population-based study

BACKGROUND

This study assesses survival improvement across a decade (2004-2013) among patients with metastatic gastrointestinal cancers in a real-world setting.

METHODS

Surveillance, Epidemiology and End Results (SEER) database was accessed and patients with metastatic gastrointestinal carcinomas who have received any form of systemic therapy were included. Patients were grouped into three cohorts based on the year of diagnosis (cohort-1: 2004-2006; cohort-2: 2008-2010; cohort-3: 2012-2013). Overall survival was compared among the three cohorts for each disease site using Kaplan-Meier survival estimates.

RESULTS

A total of 54,992 patients with metastatic gastrointestinal cancers were included in the current analysis. Using Kaplan-Meier survival comparison for the three temporal cohorts, the following survival observations were noted: for patients with metastatic esophageal adenocarcinoma: median survival for cohort-1: 8 months, cohort-2: 9 months, cohort-3: 9 months; P < 0.001; for patients with metastatic esophageal squamous cell carcinoma: median survival cohort-1: 8 months, cohort-2: 8 months, cohort-3: 8 months; P = 0.689; for patients with metastatic gastric adenocarcinoma: median survival for cohort-1: 8 months, for cohort-2: 9 months, for cohort-3: 9 months; P < 0.001; for patients with metastatic colorectal carcinoma: median overall survival for each of the three cohorts: 21 months; P = 0.131; for patients with metastatic pancreatic carcinoma: median survival for cohort-1: 5 months, cohort-2: 5 months, cohort-3: 6 months; P < 0.001; for patients with metastatic hepatocellular carcinoma: median survival of 5 months for each of the three cohorts; P = 0.534); and for patients with metastatic biliary carcinomas: median survival for cohort-1: 7 months, cohort-2: 7 months, cohort-3: 8 months; P = 0.031).

CONCLUSION

Limited (if any) survival improvement has been observed among patients with metastatic gastrointestinal carcinomas treated with systemic therapy in the decade from 2004 to 2013.

Outcomes of metastatic colorectal cancer patients in relationship to prior and concurrent antibiotics use; individual patient data analysis of three clinical trials

BACKGROUND

Antibiotic use at the time of chemotherapy has been linked with inferior outcomes among a number of solid tumors. The current study aims at further assessing this observation among metastatic colorectal cancer patients treated with first-line systemic chemotherapy.

METHODS

This is a pooled analysis of three clinical trial datasets (NCT00384176; NCT00272051; NCT00305188) that were accessed from the Project Data Sphere platform. Kaplan-Meier survival estimates were used to evaluate the impact of antibiotic use on overall and progression-free survival and multivariable Cox regression models were employed to further assess this impact.

RESULTS

A total of 1446 patients were included in the current analysis. These include 108 patients who received antibiotics before the start of chemotherapy, 499 patients who received antibiotics after the start of chemotherapy, and 839 patients who did not receive antibiotics. Using Kaplan-Meier survival estimates, the use of antibiotics prior to the start of chemotherapy was associated with worse progression-free (P = 0.001) and overall survival (P < 0.001). Likewise, when multivariable Cox regression analyses were conducted, prior antibiotic use is associated with worse progression-free (HR for antibiotic use during chemotherapy versus antibiotic use prior to chemotherapy = 0.764; 95% CI 0.604-0.966; P = 0.024) and overall survival (HR for antibiotic use during chemotherapy versus antibiotic use prior to chemotherapy = 0.710; 95% CI 0.537-0.940; P = 0.017).

CONCLUSION

Antibiotic use before (but not following) the start of 5FU-based chemotherapy is associated with worse progression-free and overall survival among patients with metastatic colorectal cancer.

ECOG performance score 0 versus 1: impact on efficacy and safety of first-line 5-FU-based chemotherapy among patients with metastatic colorectal cancer included in five randomized trials

BACKGROUND

Within the context of metastatic colorectal cancer, patients with Eastern Cooperative Oncology Group (ECOG) performance score 0-1 are usually pooled together in clinical practice guidelines and clinical trials' reports. The current study aims to delineate potential differences in outcomes between metastatic colorectal cancer patients with ECOG score 0 versus 1 who are treated with currently accepted first-line fluorouracil (5FU)-based chemotherapy.

METHODS

The current study is based on a pooled dataset from five clinical trials of 5FU-based treatment for metastatic colorectal cancer (NCT00272051; NCT00115765; NCT00305188; NCT00364013; and NCT00384176). Patients with metastatic colorectal cancer and ECOG score of 0-1 were eligible for the current study. Multivariable logistic regression analysis was used to assess the relationship between ECOG performance status and the development of different toxicities. Kaplan-Meier survival estimates were used to clarify the impact of the ECOG score on overall and progression-free survivals. Multivariable Cox regression analysis was then used to evaluate the impact of ECOG score on overall and progression-free survivals.

RESULTS

A total of 3143 patients were included in the current analysis. Within multivariable logistic regression analysis, patients with an ECOG score of 0 have a lower probability of serious adverse events (OR 0.678; 95% CI 0.583-0.788; P < 0.001), fatal adverse events (OR 0.552; 95% CI 0.397-0.766; P < 0.001), high-grade anemia (OR 0.426; 95% CI 0.252-0.721; P = 0.001), and high-grade nausea/vomiting (OR 0.697; 95% CI 0.509-0.955; P = 0.024). Through Kaplan-Meier survival analysis, patients with an ECOG score of 0 have better overall and progression-free survivals (P < 0.001 for both endpoints). Median overall survival was 27.63 months among patients with an ECOG score of 0 versus 20.00 months among patients with an ECOG score of 1. Within multivariable Cox regression analysis, patients with ECOG score of 0 were associated with better overall and progression-free survivals (HR for overall survival 0.613; 95% CI 0.556-0.676; P < 0.001); (HR for progression-free survival 0.765; 95% CI 0.705-0.829; P < 0.001).

CONCLUSION

Compared with patients with ECOG score of 1, patients with ECOG score of 0 have better overall and progression-free survival, and less probability of serious and fatal adverse events. This distinction in outcomes should be noted when choosing appropriate therapeutic strategies and when designing/reporting the results of clinical trials.