Department of Postgraduate Education in Clinical Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Oncology Clinical Research Department, Instituto D'Or de Pesquisa e Ensino, São Paulo-SP, Brazil.
Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, Brazil; Department of Postgraduate Education in Clinical Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Oncology Clinical Research Department, Instituto D'Or de Pesquisa e Ensino, São Paulo-SP, Brazil.
Clin Colorectal Cancer. 2023 Sep;22(3):291-297. doi: 10.1016/j.clcc.2023.05.001. Epub 2023 May 11.
Colorectal cancer is the second most common cancer in both genders and often presents as a metastatic, unresectable, or recurrent disease in early follow-up. It is uncertain the benefit of oxaliplatin-based palliative chemotherapy (CT) in the first line of treatment in patients with compromised performance status (PS), Eastern Cooperative Oncology Group (ECOG) 3 and 4. These patients are systematically excluded from clinical trials but may be treated in clinical practice.
We conducted a prospective observational cohort whose primary outcome was improving at least 2 points in the worst symptom in the Edmonton Symptom Assessment System Scale (ESAS-r), without grade 3 to 4 toxicity, comparing baseline and fourth week of treatment. Secondary endpoints included quality of life using the European Quality of Life-5 dimensions questionnaire, toxicity, response rate, clinical improvement of ECOG PS, and overall survival (OS).
We included 28 patients, and 12 (42.8%) achieved the primary endpoint. Median overall survival was 86 days, 46% of patients did not respond to the fourth-week reevaluation due to clinical deterioration, and 17.8% presented toxicity grade ≥3, with 5 patients dying from toxicity. In addition, ECOG PS 4 or cholestasis had poorer overall survival. Finally, 25% and 53.6% of patients received these treatments in the last 14 and 30 days of life, respectively.
In the present study, palliative multiagent chemotherapy in poor performance status patients with non-molecularly selected colorectal cancer tended to impact tumor symptoms control; however, there is no benefit in OS and a considerable risk of toxicity and treatment-related death.
结直肠癌是男女两性最常见的癌症之一，在早期随访中常表现为转移性、不可切除或复发性疾病。对于体能状态（PS）不佳的患者（Eastern Cooperative Oncology Group [ECOG] 3 或 4 级），奥沙利铂为基础的姑息性化疗（CT）是否作为一线治疗有益尚不确定。这些患者通常被排除在临床试验之外，但可能会在临床实践中接受治疗。
我们开展了一项前瞻性观察性队列研究，其主要结局是根据埃德蒙顿症状评估系统量表（Edmonton Symptom Assessment System Scale [ESAS-r]）最差症状评分至少改善 2 分，且无 3 至 4 级毒性，比较基线和治疗第 4 周。次要终点包括采用欧洲生活质量-5 维度问卷（European Quality of Life-5 dimensions questionnaire）评估的生活质量、毒性、缓解率、ECOG PS 的临床改善以及总生存（overall survival，OS）。
我们共纳入了 28 例患者，其中 12 例（42.8%）达到了主要终点。中位总生存时间为 86 天，46%的患者因临床恶化在第 4 周评估时无反应，17.8%出现了≥3 级毒性，5 例患者因毒性死亡。此外，ECOG PS 4 级或胆汁淤积的患者 OS 更差。最后，分别有 25%和 53.6%的患者在生命的最后 14 天和 30 天接受了这些治疗。
在本研究中，姑息性多药化疗在非分子选择的结直肠癌体能状态不佳的患者中可能有助于控制肿瘤症状，但对 OS 无益，且毒性和治疗相关死亡风险较高。
