Predicting mortality and adverse events in patients with advanced pancreatic cancer treated with palliative gemcitabine-based chemotherapy in a multicentre phase III randomized clinical trial: the APC-SAKK risk scores.
advanced pancreatic cancer
chemotherapy
inflammatory markers
mortality
prediction score
toxicity
Journal
Therapeutic advances in medical oncology
ISSN: 1758-8340
Titre abrégé: Ther Adv Med Oncol
Pays: England
ID NLM: 101510808
Informations de publication
Date de publication:
2019
2019
Historique:
received:
05
07
2018
accepted:
01
10
2018
entrez:
15
1
2019
pubmed:
15
1
2019
medline:
15
1
2019
Statut:
epublish
Résumé
The prognosis of advanced pancreatic cancer (APC) is poor and differs considerably among patients. Therefore, it is clinically relevant to identify patients with APC who are more likely to benefit from palliative chemotherapy with reduced risk of toxicity. To date, there is no prognostic score universally recommended to help clinicians in planning the therapeutic management. Using individual patient data from 319 cases of APC treated with gemcitabine-based chemotherapy and enrolled in the SAKK 44/00-CECOG/PAN.1.3.001 randomized trial, several baseline variables, including inflammatory markers, were analysed Median survival of the study patients was 7.9 months (interquartile range 3.7-13.3 months). Independent predictors of mortality included increased Aspartate transaminase (ASAT), low performance status, increased derived neutrophil to lymphocyte ratio, increased Carbohydrate Antigen 19-9 (CA 19-9), low haemoglobin, presence of pain, presence of metastasis and increased alkaline phosphatase (ALP). During the study, 117 patients experienced at least one grade 3 or 4 adverse event. Independent predictors of toxicity included white blood cells, ALP, renal function and bilirubin levels at baseline. Both models displayed moderate levels of discrimination (C-statistic 0.68 and 0.64 for mortality and toxicity, respectively) and adequate calibration. We developed simple-to-use prognostic scores for mortality and severe toxicity for patients with APC. These scores can be useful in daily practice to identify patients with increased risk of death or toxicity and to plan the most appropriate therapeutic strategy to improve survival and quality of life. Further prospective studies to validate such scores are needed.
Sections du résumé
BACKGROUND
BACKGROUND
The prognosis of advanced pancreatic cancer (APC) is poor and differs considerably among patients. Therefore, it is clinically relevant to identify patients with APC who are more likely to benefit from palliative chemotherapy with reduced risk of toxicity. To date, there is no prognostic score universally recommended to help clinicians in planning the therapeutic management.
METHODS
METHODS
Using individual patient data from 319 cases of APC treated with gemcitabine-based chemotherapy and enrolled in the SAKK 44/00-CECOG/PAN.1.3.001 randomized trial, several baseline variables, including inflammatory markers, were analysed
RESULTS
RESULTS
Median survival of the study patients was 7.9 months (interquartile range 3.7-13.3 months). Independent predictors of mortality included increased Aspartate transaminase (ASAT), low performance status, increased derived neutrophil to lymphocyte ratio, increased Carbohydrate Antigen 19-9 (CA 19-9), low haemoglobin, presence of pain, presence of metastasis and increased alkaline phosphatase (ALP). During the study, 117 patients experienced at least one grade 3 or 4 adverse event. Independent predictors of toxicity included white blood cells, ALP, renal function and bilirubin levels at baseline. Both models displayed moderate levels of discrimination (C-statistic 0.68 and 0.64 for mortality and toxicity, respectively) and adequate calibration.
CONCLUSIONS
CONCLUSIONS
We developed simple-to-use prognostic scores for mortality and severe toxicity for patients with APC. These scores can be useful in daily practice to identify patients with increased risk of death or toxicity and to plan the most appropriate therapeutic strategy to improve survival and quality of life. Further prospective studies to validate such scores are needed.
Identifiants
pubmed: 30636977
doi: 10.1177/1758835918818351
pii: 10.1177_1758835918818351
pmc: PMC6317152
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1758835918818351Déclaration de conflit d'intérêts
Conflict of interest statement: The authors declare no conflicts of interest in preparing this article.
Références
Oncology. 2000 Nov;59(4):296-301
pubmed: 11096341
J Clin Oncol. 2007 Jun 1;25(16):2212-7
pubmed: 17538165
Lancet Oncol. 2008 Feb;9(2):132-8
pubmed: 18249033
Anticancer Res. 2008 Jan-Feb;28(1B):543-9
pubmed: 18383900
J Clin Oncol. 2008 Aug 1;26(22):3695-701
pubmed: 18669454
Cancer Med. 2014 Apr;3(2):406-15
pubmed: 24519894
Ann Surg Oncol. 2015 Feb;22(2):670-6
pubmed: 25155401
Ann Oncol. 2015 Apr;26(4):743-9
pubmed: 25515657
Cancer Chemother Pharmacol. 2015 Mar;75(3):457-64
pubmed: 25547407
Oncologist. 2015 Feb;20(2):143-50
pubmed: 25582141
Int J Clin Oncol. 2016 Feb;21(1):118-25
pubmed: 26123314
Chin J Cancer Res. 2015 Oct;27(5):509-15
pubmed: 26543338
PLoS One. 2015 Nov 06;10(11):e0142159
pubmed: 26544968
Lancet. 2016 Jul 2;388(10039):73-85
pubmed: 26830752
Cancer Res Treat. 2016 Oct;48(4):1253-1263
pubmed: 26875200
Br J Cancer. 2016 Jul 26;115(3):281-9
pubmed: 27404456
Cancer Treat Rev. 2017 Jul;58:1-13
pubmed: 28602879
Lancet Oncol. 2018 Mar;19(3):e151-e160
pubmed: 29508762