P-281 - The GERCOR and Köhne prognostic models in metastatic colorectal cancer (mCRC) patients treated with bevacizumab-based first-line therapy: compariso...

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Colon Cancer
Rectal Cancer
Pathology/Molecular Biology
Presenter G. Bruixola
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors G. Bruixola1, R. Diaz Beveridge1, M. Melian1, E. Reche1, C. Escoín1, O. Niño1, C. Salvador1, D. Akhoundova1, E. Navarro1, S. Palanca1, J. Caballero1, A. Giménez1, A. Segura1, J. Aparicio2
  • 1La Fe University and Polytechnic Hospital, Valencia/ES
  • 2Hospital Universitario La Fe, Valencia/ES

Abstract

Introduction

The Köhne risk classification was established in mCRC patients (pts) treated with 5-fluorouracil-based chemotherapy. (Ann Oncol 2002;12:308-317). Afterwards the GERCOR group developed a prognostic model for pts treated with an oxaliplatin-based or irinotecan-based 1st-line chemotherapy. (The Oncologist 2011;16:1228-1238). Bevacizumab (Bev) in combination with FOLFOX/FOLFIRI has shown a survival benefit in the 1st-line therapy and is considered a standard of treatment in mCRC; however, validated prognostic models are not available in these pts treated with antiangiogenics.

Methods

Retrospective review of FOLFOX/FOLFIRI-Bev treated pts (2006-2013). Progression-free survival (PFS) and OS were assessed. Univariate and multivariate analysis of prognostic factors for OS was performed. To study the correlation between the Köhne and GERCOR prognostic models, each model's predicted survival was plotted and a Pearson's correlation coefficient was used to analyze the similarity between these two prognostic indexes.

Results

124 pts found. Baseline characteristics in Table 1. With a median follow-up of 65 months (mts) (range 22-112), median (m) PFS and OS was 10.9 (CI95% 9,1-12,8) and 26.8 mts (CI95% 19,4-34,4), respectively. The 1-, 2-, and 5-year OS rate was of 84%, 59% and 14%.

Univariate analysis: Performance status (PS) = 2, anemia, hypoalbuminemia, high CA 19.9 baseline level, elevated serum lactate dehydrogenase (LDH) at baseline, > 1 metastatic site, were all significant poor prognostic factors. In the multivariate study, only PS, number of metastatic sites, and serum LDH retained their significant prognostic value.

By applying the Köhne model, mOS was 35.2 mts (CI95% 28-42.3) in the low-risk group, 24.1 mts (CI95% 18.2-30.1) in the intermediate-risk group and 3.6 mts (CI95% 0.1-7.9) in the high-risk group. (p-value < 0.0001).

According to the GERCOR model, mOS was 38.8 mts (CI95% 25.1-52.4) in the low-risk group, 26.1 mts (CI95% 15.7-36.5) in the intermediate-risk and 17.1 mts (CI95% 14.7-19.5) in the high-risk group, respectively (p-value< 0.0001).

A moderate positive relationship was confirmed between them, with a Pearson coefficient of 0,413 that was statistically significant (p-value < 0,0001).

Conclusion

PS, serum LDH baseline value, number of metastatic sites were the main prognostic factors in our pts treated with 1st-line FOLFOX/FOLFIRI-Bev. The GERCOR prognostic appears to have advantages over the Köhne model for risk-stratification of patients outside clinical trials, especially in the selection of higher-risk patients.

Table: P-281