Abstract 123P
Background
Determining prognosis in cancer is crucial for patients and clinicians, as well as deciding eligibility for early clinical trials. Existing prognostic indices, such as the Royal Marsden Hospital Score, combine parameters reflecting homeostasis, tumour burden and functional status. However, these scores assess parameters at a single time point and might be refined by repeated measurements as patients approach the end of life.
Methods
PROSPECT NE (17/NE/0208) was an observational pilot study in patients referred for early clinical trials at the Newcastle Experimental Cancer Medicine Centre, Newcastle upon Tyne, UK, who died between 2022 and 2023. This study aimed to identify the chronology of changes in metabolism, quality of life and function in patients with cancer approaching the end of life. Data were collected from 79 patients at up to four different time points between 14/09/2017 and 25/02/2020. Data included routine haematology and biochemistry tests, including C-Reactive Protein, physical characteristics (Grip strength and weight), performance status, quality of life assessments (including EORTC QLQ-C30 and EQ-5D ) and serological biomarkers associated with frailty in a study of Ageing (including Myeloperoxidase, Transforming Growth Factor -B and Insulin Growth Factor Binding Protein 1).
Results
Unsupervised hierarchical clustering indicates four clusters of changes in routine chemistry and haematological biomarkers reflecting inflammation, metabolic disturbance and a catabolic state occurring at 0 to 30 days, 30 to 150 days, 151 to 240 days, and 241+ days before death. These changes also correlate with a decline in QOL assessments and increasing symptomatology, including fatigue.
Conclusions
This observational study showed a gradual deterioration over the last year of life in several factors, accelerating over the last five months. Future studies should focus on the further development of tools to estimate prognosis and assessment of user acceptance.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Newcastle upon Tyne Hospitals NHS Foundation Trust.
Funding
Sir Bobby Robson Foundation.
Disclosure
A. Greystoke: Financial Interests, Personal, Advisory Board: BMS, AstraZeneca, Boehringer Ingelheim, Takeda, Roche, Novartis; Financial Interests, Personal, Invited Speaker: Merck, MSD, Pfizer, Janssen; Financial Interests, Institutional, Invited Speaker: MSD, Pfizer, AstraZeneca, Novartis, Achilles; Non-Financial Interests, Personal, Advisory Role: National Institute for Health and Clinical Excellence; Non-Financial Interests, Personal, Leadership Role, Steering Committee member: British Thoracic Oncology Group; Other, Personal, Other, Clinical Lead for Cancer (paid position): North East England and Yorkshire Genomic Laboratory Hub. R. Plummer: Financial Interests, Personal, Advisory Board: Pierre Faber, Bayer, Novartis, BMS, Cybrexa, Ellipses, CV6 Therapeutics, Astex Therapeutics, Sanofi Aventis, Immunocore, Genmab, Medivir, Onexo, Incyte; Financial Interests, Institutional, Royalties, Royalties relating to rucaparib licencing: Clovis Oncology; Financial Interests, Personal, Other, Honorarium as member of IDMC: Sotio, Alligator Biosciences, AstraZeneca; Financial Interests, Personal, Other, Honoraria as member of IDMC: GSK. All other authors have declared no conflicts of interest.