Real-World Treatment and Outcomes of Metastatic Colorectal Cancer Patients With a Poor or Very Poor Performance Status

医学 结直肠癌 内科学 全身疗法 共病 比例危险模型 人口 多元分析 癌症 性能状态 临床试验 肿瘤科 环境卫生 乳腺癌
作者
Avraham Travers,Azim Jalali,Stephen Begbie,Christine Semira,Suzanne Kosmider,Sumitra Ananda,Rachel Wong,Margaret Lee,Jeremy Shapiro,Matthew Burge,Desmond Yip,Javier Torres,Brigette Ma,Louise Nott,Andrew Dean,Jeanne Tie,Adnan Khattak,Stephanie Lim,Hui‐Li Wong,Peter Gibbs
出处
期刊:Clinical Colorectal Cancer [Elsevier BV]
卷期号:20 (1): e21-e34 被引量:4
标识
DOI:10.1016/j.clcc.2020.08.002
摘要

The management of metastatic colorectal cancer patients with a poor performance status (PS) continues to be a clinical dilemma, with the potential activity and safety of treating this population remaining poorly understood. Few of these patients are enrolled onto clinical trials, and poor PS is often multifactorial.We analyzed the Treatment of Recurrent and Advanced Colorectal Cancer registry to describe treatment practices and outcomes in poor (Eastern Cooperative Oncology Group [ECOG] PS 2) and very poor PS (ECOG PS > 2) patients to explore the relationship between age, tumor burden, comorbidities, and PS, and to evaluate the benefit of systemic therapy. Standard descriptive statistical methods, Kaplan-Meier analysis, and a multivariate Cox regression model were used.Of 2769 registry patients (diagnosed January 2009 to June 2018), 329 (12%) and 182 (7%) patients had a poor and very poor PS, respectively. Good PS patients were more likely to receive systemic therapy than poor and very poor PS patients (85%, 55%, and 21.5%, P < .0001), but clinician assessed response was observed in all subsets (53%, 41%, and 29%, P = .0003). Treatment with chemotherapy was associated with longer median overall survival across PS groups. Exploratory analysis based on comorbidity score and tumor burden subgroups demonstrated a consistently positive overall survival association with treatment. Benefit was observed where poor overall survival was attributable to medical comorbidities and to tumor burden.In routine clinical care, a substantial proportion of poor and very poor PS patients receive active treatment, which is often associated with meaningful clinical benefit.
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