1354P - A score to guide the decision for retreatment after 2 lines of systemic palliative therapy for solid tumors. A prospective study

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Palliative Care
Presenter Brice Chanez
Citation Annals of Oncology (2014) 25 (suppl_4): iv471-iv477. 10.1093/annonc/mdu350
Authors B. Chanez1, M. Gilabert2, A. Madroszyk3, F. Rousseau1, D. Perrot1, F. Bertucci4, P. Viens5, J. Raoul6
  • 1Medical Oncology, Institut Paoli-Calmettes, 13009 - Marseille/FR
  • 2Medical Oncology, Institute Paoli Calmettes, 13274 - Marseille CEDEX /FR
  • 3Medical Oncology, Paoli Calmettes, 13009 - Marseille/FR
  • 4Medical Oncology, Institute Paoli Calmettes, 13274 - Marseille CEDEX/FR
  • 5Cancer Center, Institute Paoli Calmettes, 13274 - Marseille CEDEX /FR
  • 6Oncologie Digestive, Institut Paoli-Calmettes, 13273 - Marseille/FR

Abstract

Aim

In most cancers we do not have clear therapeutic guidelines after the second line of chemotherapy. A score, using 4 criteria, has been built from a multivariate analysis of a cohort of 177 advanced –stage cancers without specific treatment * and was clearly associated with the prognosis. Our aim was to test this score in patients receiving a 3rd or 4th + line in a palliative setting, in order to better define patients who will have a very poor prognosis and should benefit from best supportive care alone.

Methods

Were included in this prospective series, patients with solid tumors (except breast cancer) who had received more than 2 chemotherapy lines in a palliative setting and who are planned to receive a third line. The day before the first cycle the 4 parameters were collected and the score calculated (PS 0-1: 0 Points; 2: 2 Pts; 3-4: 4 Pts – metastatic sites: 1: 0 Pts; > 2: 2 Pts - Albumin: < 33 g/L: 0 Pts; >33 g/L - 3 Pts - LDH < 600: 0 Pt; > 600: 1 Pt; score = total + 3 Pts, ranging from 0 to 10) and associated with the outcome (overall survival – comparison by log-rank test ).

Results

From August 2013 to March 2014, 64 patients were included. The primary was: sarcoma in 15 Patients, colo-rectal cancer: 14, lung cancer: 11, ovarian cancer : 11, pancreatic cancer: 5, gastric cancer: 4, other: 4.They have previously received: 2 lines in 32 cases, 3 in 17, 4 in 6 and more than 5 lines in 9 cases. Median overall survival (mOS) of the cohort was 4.4 mo, 3 and 6-mo OS were respectively 63 and 46 %. mOS was clearly related with the score. Patients with a good score (0 to 3; n = 27) had a mOS not reached and 3 and 6 mo OS of 100 and 67%; those with a score between 4–6 (n = 15) had a mOS of 3.4 mo, and 3 and 6 mo OS of 52 and 41% while those having a score from 7–10 (m = 22) had a mOS of 1.3 months and 3–6 months OS of 25–0%. Overall survival was significantly (log-rank) different (p < 0.0001) between these 3 groups. If we exclude PS 3-4 patients (n = 14), usually not candidate for systemic treatments, 3 and 6 months OS were: 100, 66% for good score group, 58, 48% for the intermediate score group and 41 and 0% for the poor score group (p < 0.001).

Conclusions

Conclusions: this score, very easy to determine, will help medical oncologist to decide which patients should not receive an additional line of chemotherapy due to predicted poor overall survival under treatment. *Barbot AC, et al. J Clin Oncol 2008; 15: 2538-43

Disclosure

All authors have declared no conflicts of interest.