ABSTRACT
BACKGROUND: A rising number of metastatic cancer patients are receiving palliative systemic therapy close to end of life. Patients started on such treatment are typically judged by oncologists to have at least 12 weeks survival, however, accurate survival prediction on individual patients is difficult. Systemic therapy started too late may not benefit patient, but rather, adversely affect patient's quality of life and may even shorten survival due to treatment-related side effects. Our objective is to identify factors correlating with a shorter (≤6 weeks) non-malignancy related survival in metastatic cancer patients receiving palliative systemic therapy, so as to aid oncologist in the decision-making of starting treatment or not. METHODS: A review of deceased metastatic cancer patients treated with palliative systemic therapy and died between January 2013 and December 2014 was carried out. They were subcategorized into dying within or after 6 weeks since starting their last line of palliative systemic therapy, and also by cause of death (malignancy-related or non-malignancy related causes). Demographics, clinical characteristics, and type of systemic therapy used were assessed using non-parametric Mann Whitney-U tests for continuous variables and χ2 tests for categorical variables. Univariable analyses were carried out to determine associations of different variables with non-malignancy related death that happened within 6 weeks of starting their last line of palliative systemic therapy. Multivariable analyses were carried out with significant factors in univariable analyses to determine their independent effect. RESULTS: Seven hundred and fifty-four patients were analyzed. Mean age was 63.6 (range, 21-102); female 48.7%. Older age (75 years) (P=0.007) and active liver metastasis (P=0.042) were significant predictors for early (≤6 weeks) non-malignancy related death in multivariable analysis. They have 2.012 and 1.115 times higher chance respectively to die of non-malignant causes within 6 weeks since the start of their last line of palliative systemic treatment. CONCLUSIONS: Oncologists should exercise extra caution when encountering elderly patients with active liver metastasis, especially with regard to the issue of starting palliative systemic therapy.
Subject(s)
Neoplasms , Oncologists , Terminal Care , Aged , Female , Humans , Middle Aged , Neoplasms/therapy , Palliative Care , Quality of LifeABSTRACT
BACKGROUND: Cetuximab in combination with oral fluoropyrimidine (FP) remains controversial in metastatic colorectal cancer (mCRC). In view of the regional variation in the tolerability of FP, we conducted a retrospective analysis to compare oral FP with infusional FP in combination with cetuximab in Chinese population. AIM: To compare the efficacy and safety profile of cetuximab in combination with oral FP and infusional FP in Chinese population in the real-world setting. METHODS: A retrospective cohort study was done to analyse consecutive patients with Kras wild-type mCRC who received first-line treatment with cetuximab and FP-based chemotherapy in our unit from January 2010 to December 2015. Ninety-five eligible patients were included. The median follow-up of our cohort was 65.0 mo. RESULTS: The median progression-free survival (mPFS) and median overall survival (mOS) of the entire cohort were 9.66 mo (95%CI: 7.72-12.5) and 25.8 mo (95%CI: 18.7-35.6), respectively. Between oral FP and infusional FP, there was no statistical significant difference in the mPFS [9.79 mo (95%CI: 7.49-12.7) vs 9.63 mo (95%CI: 6.34-13.4); P = 0.72] and mOS [25.8 mo (95%CI: 15.2-35.6) vs 26.3 mo (95%CI: 18.7-41.2); P = 0.63]. Grade 3 or above adverse events were reported in 28.4% of patients, being similar with oral and infusional FP, and included 10.5% of neutropenia and 2.1% of diarrhoea events. CONCLUSION: The current analysis demonstrates comparable efficacy and safety profiles of cetuximab in combination with oral and infusional FP in Chinese population. The results expand treatment options for Chinese patients and invite revision of existing treatment guidelines to incorporate oral FP-based chemotherapy plus cetuximab.
ABSTRACT
BACKGROUND: The efficacy and safety of using combination chemotherapy with cetuximab as first-line treatment in patients with K-ras wild-type colorectal cancers has been well established. In general, weekly cetuximab was given with biweekly chemotherapy FOLFOX-4 or FOLFIRI, synchronizing them would be appealed to both patients and health care professionals. MATERIALS AND METHODS: This Phase II, prospective study investigated the efficacy and safety of using biweekly cetuximab 500 mg/m(2) with chemotherapy FOLFOX-4 or FOLFIRI as first-line treatment for Chinese patients with K-ras wild-type metastatic colorectal cancer. The study endpoints included overall objective response (OR), progression-free survival (PFS), overall survival (OS) and safety. RESULTS: Total 15 Chinese patients (male: 10 [67%]; median age: 60 [range 41-80]) were enrolled. Patients received median 12 cycles (range 2-12) of chemotherapy + cetuximab (FOLFOX-4 + cetuximab: 9 [60%]; FOLFIRI + cetuximab: 6 [40%]). Six patients (40%) with non-progressive disease after 12 cycles of chemotherapy + cetuximab carried on maintenance cetuximab. Median duration of follow-up (FU) was 23.7 months. The OR was 40% (complete response: 0%; partial response: 40%) for a disease control rate of 87%. Median PFS and OS were 7.8 months and 17.9 months respectively. For maintenance cetuximab phase, median PFS since the start of maintenance cetuximab was 6.8 months and median OS was 17.0 months. The only grade 3-4 toxicities were neutropenia (26.7%) in chemotherapy phase and acneiform rashes (16.7%) in maintenance phase. CONCLUSIONS: Biweekly cetuximab with combination chemotherapy was effective and safe as weekly dose. Further studies are warranted for the role of maintenance cetuximab.
