Abstract 3554
Background
ECOG 2-3 patients are poorly represented in prospective studies (only 7% in Sorbye et al, Ann Oncol 2007) and efficacy outcomes are poor. Natural course of mCRC and metastasectomies were the primary endpoints of this prospective Finnish nationwide study initiated in 2011.
Methods
1086 mCRCs referred for oncological treatments at all 21 oncology units (40% of eligible mCRCs in Finland) were included. Prognostic and predictive factors, resectability, treatment history and outcome measures were assessed.
Results
Baseline ECOG was 0 in 295 (27%), 1 in 600 (55%) and 2-3 in 191 (18%). Strongest baseline patient characteristics in multivariable logistic regression models (n = 851) for ECOG 2-3 status were: age >70 (odds ratio 3.00), BMI <20 (2.26), >3 comorbidities (2.61), >3 regular drugs (1.67), >2 symptoms at mCRC diagnosis (3.05), abnormal physical exam (2.22), bone metastases (3.37), BRAF mutation (2.44), neutrophil-to-lymphocyte ratio >3.00 (2.75), alkaline phosphatase ALP >300 (3.08), leukocytes >10 (1.88), haemoglobin <11 (1.70) and in univariable analysis also, daily drinking (2.55), smoking (1.98), primary in-situ (2.38), >3 metastatic sites (1.92), synchronous mets (1.77); suprarenal (2.87), liver (1.53) and lymph node metastases (1.44); neutrophils >6.7 (4.54), platelets >400 (1.73), CRP >10 (3.37), albumin <30 (4.70), CEA >5 (2.51) and Ca19-9 >25 (1.61). Sex, second cancers, sidedness, RAS status or MSI-H were not associated with ECOG 2-3 status. In ECOG 0 / 1 / 2-3 median overall survival (OS) was 46.0 / 29.1 / 13.2 months and progression free survival (PFS) 18.6 / 12.5 / 7.0 months, respectively. Cox proportional hazards models for OS and PFS suggested that baseline ECOG 2-3, bone metastases, BRAF mutation, >3 metastatic sites, elevated ALP or leukocytes were the strongest predictors of poor OS and PFS.
Conclusions
Poor performance status is characterized by comorbidities, drinking and smoking; cancer-related symptoms, tumour burden, laboratory alterations and inflammatory activity. ECOG 2-3 is one of the strongest prognostic factors, and OS is shortened by > 12 months per ECOG class and PFS by 6 months.
Clinical trial identification
NCT01531621.
Editorial acknowledgement
Legal entity responsible for the study
The authors of the RAXO-study group.
Funding
Finska Läkaresällskapet, The Finnish Cancer Foundation, the Competitive State Research Financing of the Expert Responsibility Area of Tampere and Helsinki University Hospitals, Amgen - unrestricted grant, Eli Lilly, Merck, Roche, Sanofi and Servier - unrestricted grant.
Disclosure
P.J. Österlund: Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Amgen; Honoraria (self), Advisory / Consultancy: Bayer; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Celgene; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Lilly; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Merck; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution), Travel / Accommodation / Expenses: Nordic Drugs; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Sanofi; Honoraria (self), Speaker Bureau / Expert testimony, Research grant / Funding (institution): Baxalta/Servier; Honoraria (self), Speaker Bureau / Expert testimony: Eisai; Travel / Accommodation / Expenses: AbbVie; Travel / Accommodation / Expenses: AstraZeneca; Travel / Accommodation / Expenses: Pierre Fabre. T. Salminen: Advisory / Consultancy, Travel / Accommodation / Expenses: Celgene; Advisory / Consultancy, Research grant / Funding (institution): Amgen; Advisory / Consultancy, Research grant / Funding (institution): Merck; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Roche; Advisory / Consultancy, Research grant / Funding (institution): Sanofi; Advisory / Consultancy, Research grant / Funding (institution): Servier; Speaker Bureau / Expert testimony: Novartis. A. Algars: Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Amgen; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Servier; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Merck; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Sanofi; Travel / Accommodation / Expenses: Varian; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Lilly. L. Soveri: Advisory / Consultancy, Travel / Accommodation / Expenses: Roche; Advisory / Consultancy: Amgen; Advisory / Consultancy, Travel / Accommodation / Expenses: Servier; Advisory / Consultancy: Lilly; Advisory / Consultancy: Merck; Advisory / Consultancy: MSD; Advisory / Consultancy: Sanofi. R. Ristamäki: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Amgen; Honoraria (self): Astellas; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Lilly; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Merck; Honoraria (self): Novartis; Travel / Accommodation / Expenses: Ipsen; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Sanofi; Advisory / Consultancy, Research grant / Funding (institution): Servier. R.S. Kallio: Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Amgen; Advisory / Consultancy: Bayer; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Lilly; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Merck; Travel / Accommodation / Expenses: MSD; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Sanofi; Advisory / Consultancy, Travel / Accommodation / Expenses: Servier. A. Lamminmäki: Advisory / Consultancy, Research grant / Funding (institution): Amgen; Advisory / Consultancy, Research grant / Funding (institution): Merck; Travel / Accommodation / Expenses: MSD; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Advisory / Consultancy, Research grant / Funding (institution): Sanofi; Advisory / Consultancy, Research grant / Funding (institution): Servier; Travel / Accommodation / Expenses: Kyowa Kirin; Travel / Accommodation / Expenses: Astellas; Travel / Accommodation / Expenses: Pfizer; Travel / Accommodation / Expenses: Ipsen; Travel / Accommodation / Expenses: BMS. T. Poussa: Honoraria (institution): Boehringer Ingelheim. E. Lantto: Advisory / Consultancy, Research grant / Funding (institution): Amgen; Advisory / Consultancy, Research grant / Funding (institution): Merck; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Advisory / Consultancy, Research grant / Funding (institution): Roche; Advisory / Consultancy, Research grant / Funding (institution): Sanofi; Advisory / Consultancy, Research grant / Funding (institution): Servier. A. Ovissi: Advisory / Consultancy, Research grant / Funding (institution): Amgen; Advisory / Consultancy, Research grant / Funding (institution): Merck; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Advisory / Consultancy, Research grant / Funding (institution): Roche; Advisory / Consultancy, Research grant / Funding (institution): Sanofi; Advisory / Consultancy, Research grant / Funding (institution): Servier. A. Nordin: Research grant / Funding (institution): Amgen; Research grant / Funding (institution): Lilly; Honoraria (institution): Merck; Research grant / Funding (institution): Roche; Research grant / Funding (institution): Sanofi; Research grant / Funding (institution): Servier. P. Nyandoto: Advisory / Consultancy: MSD; Advisory / Consultancy: Merck; Advisory / Consultancy: Roche; Advisory / Consultancy: Sanofi; Advisory / Consultancy: Servier; Advisory / Consultancy: Lilly. J.T. Kononen: Advisory / Consultancy: Amgen; Research grant / Funding (self): Merck; Advisory / Consultancy: Lilly; Advisory / Consultancy: Roche; Advisory / Consultancy: Sanofi; Advisory / Consultancy: Servier; Honoraria (self): Celgene; Advisory / Consultancy: BMS. L.J. Aroviita: Advisory / Consultancy, Research grant / Funding (institution): Amgen; Advisory / Consultancy, Research grant / Funding (institution): Merck; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Advisory / Consultancy, Research grant / Funding (institution): Roche; Advisory / Consultancy, Research grant / Funding (institution): Sanofi; Advisory / Consultancy, Research grant / Funding (institution): Servier. A. Jekunen: Advisory / Consultancy, Travel / Accommodation / Expenses: Roche; Advisory / Consultancy, Travel / Accommodation / Expenses: Lilly; Advisory / Consultancy, Travel / Accommodation / Expenses: BMS; Advisory / Consultancy, Travel / Accommodation / Expenses: Sanofi; Advisory / Consultancy, Travel / Accommodation / Expenses: Bayer; Advisory / Consultancy, Travel / Accommodation / Expenses: MSD; Advisory / Consultancy, Travel / Accommodation / Expenses: Pfizer; Advisory / Consultancy: Ibsen; Travel / Accommodation / Expenses: Merck; Advisory / Consultancy, Travel / Accommodation / Expenses: AstraZeneca; Advisory / Consultancy: Takeda. M. Murashev: Advisory / Consultancy, Research grant / Funding (institution): Amgen; Advisory / Consultancy, Research grant / Funding (institution): Merck; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Advisory / Consultancy, Research grant / Funding (institution): Roche; Advisory / Consultancy, Research grant / Funding (institution): Sanofi; Advisory / Consultancy, Research grant / Funding (institution): Servier. R. Lindvall-Andersson: Advisory / Consultancy, Research grant / Funding (institution): Amgen; Advisory / Consultancy, Research grant / Funding (institution): Merck; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Advisory / Consultancy, Research grant / Funding (institution): Roche; Advisory / Consultancy, Research grant / Funding (institution): Sanofi; Advisory / Consultancy, Research grant / Funding (institution): Servier. H. Isoniemi: Advisory / Consultancy, Research grant / Funding (institution): Amgen; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Advisory / Consultancy, Research grant / Funding (institution): Merck; Advisory / Consultancy, Research grant / Funding (institution): Roche; Advisory / Consultancy, Research grant / Funding (institution): Sanofi; Advisory / Consultancy, Research grant / Funding (institution): Servier. All other authors have declared no conflicts of interest.
Resources from the same session
5458 - Baseline characteristics from CLARINET FORTE: Evaluating lanreotide autogel (LAN) 120 mg every 14 days in patients with progressive pancreatic or midgut neuroendocrine tumours during a standard first-line LAN regimen.
Presenter: Philippe Ruszniewski
Session: Poster Display session 2
Resources:
Abstract
1234 - Analysis of PD-1/PD-L1 blockade biomarker and immune infiltrates in Gastroenteropancreatic neuroendocrine carcinoma
Presenter: Jia Zhang Xing
Session: Poster Display session 2
Resources:
Abstract
1517 - Diabetes Is Associated With Pancreatic Neuroendocrine Tumors Growth and Metastasis
Presenter: Zhiyao Fan
Session: Poster Display session 2
Resources:
Abstract
2145 - Investigation of the reclassification of G1/G2 pancreatic neuroendocrine neoplasms by WHO 2017 classification
Presenter: Takahiro Yokose
Session: Poster Display session 2
Resources:
Abstract
3134 - Treatment with somatostatin analogues after radiopeptide therapy
Presenter: Daria Handkiewicz Junak
Session: Poster Display session 2
Resources:
Abstract
2191 - Safety and Tolerability of Surufatinib in Western Patients with Solid Tumors
Presenter: Erika Hamilton
Session: Poster Display session 2
Resources:
Abstract
3253 - The impact of tumour absorbed dosimetry with survival outcomes after peptide receptor radionuclide therapy in metastatic neuroendocrine tumours.
Presenter: Rahul Ladwa
Session: Poster Display session 2
Resources:
Abstract
3581 - Opportunist and Serious Infections in Patients with Neuroendocrine Tumors Treated With Everolimus: A Multicenter Study of Real World Patients
Presenter: Carine Mauro
Session: Poster Display session 2
Resources:
Abstract
5374 - Establishment of Prognostic Nomogram Based on the Metastatic Lymph Nodes Ratio for Patients with Gastric Neuroendocrine Tumour
Presenter: yaobin lin
Session: Poster Display session 2
Resources:
Abstract
3951 - Neutrophil-lymphocyte ratio as an independent predictive factor in Neuroendocrine Neoplasms
Presenter: Sofia Ferreira
Session: Poster Display session 2
Resources:
Abstract