410P Prognostic value of baseline ECOG performance status, frailty phenotype, and geriatric screening tools (G8 and VES-13) in vulnerable older patients with metastatic colorectal cancer: The randomized NORDIC9-study

Appropriate patient selection based on functional status is crucial when considering older adults for palliative chemotherapy. This pre-planned analysis of the randomized NORDIC9-study explores the prognostic value of four functional status measures regarding progression-free survival (PFS) and overall survival (OS) in vulnerable older patients with metastatic colorectal cancer (mCRC) receiving palliative chemotherapy. Patients ≥70 years of age with mCRC not candidates for standard full-dose combination chemotherapy were randomized to receive either full-dose S1 or reduced-dose S1 plus oxaliplatin. At baseline, functional status was assessed using ECOG performance status (ECOG PS), frailty phenotype, Geriatric 8 (G8), and Vulnerable Elderly Survey-13 (VES-13). Multivariable regression models were applied and C-statistics were estimated. In total, 160 patients with a median age of 78 years (IQR: 76-81) were included. While in univariate analyses, ECOG PS, frailty phenotype, and VES-13 were associated with significant differences in OS between subgroups, G8 was not. However, a trend toward statistical significance was observed (HR: 1.55 95%CI: 0.99-2.41, p=0.050). In multivariable analyses adjusted for age, sex, BMI, and treatment allocation, we found significant differences between subgroups for all applied tools (Table); best prediction was seen for ECOG PS and VES-13 with C-statistics in the moderate range. Concerning PFS, significant differences were observed between subgroups of ECOG PS, G8, and VES-13 both in uni- and multivariable analyses, but not for frailty phenotype.Table: 410PProgression-free and overall survival according to functional status measurements multivariable analysesPhysical functioning measurementsnProgression-free survivalOverall survivalHR95% CIp-valueHarrell’s CHR95% CIp-valueHarrell’s CECOG PS0531.000.631.000.631751.551.05-2.290.0281.991.26-3.160.0032322.471.48-4.120.0013.321.89-5.83<0.001Frailty phenotypeNon-frail1311.000.1760.571.000.0250.58Frail291.350.86-2.081.681.07-2.65Geriatric 8>14441.000.0110.581.000.0380.59≤141101.651.12-2.421.621.03-2.55Vulnerable Elderly Survey-130-21131.000.0030.601.00<0.0010.61≥3361.811.22-2.702.291.48-3.56 Open table in a new tab All applied tools showed prognostic value; moderate predictive power of ECOG PS and VES-13 was demonstrated in vulnerable older patients with mCRC receiving palliative chemotherapy.