A scoring system to guide the decision for a new systemic treatment after at least two lines of palliative chemotherapy for metastatic cancers: a prospective study

• Published in: Supportive care in cancer Vol. 25; no. 9; pp. 2715 - 2722
• Main Authors: Chanez, Brice, Bertucci, François, Gilabert, Marine, Madroszyk, Anne, Rousseau, Frédérique, Perrot, Delphine, Viens, Patrice, Raoul, Jean-Luc
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2017; Springer; Springer Nature B.V; Springer Verlag (Germany)
• Subjects: Adult; Aged; Aged, 80 and over; Albumin; Cancer; Cancer metastasis; Cancer research; Care and treatment; Chemotherapy; Clinical Decision-Making - methods; Clinical practice guidelines; Evidence-based medicine; Female; Health aspects; Humans; Life Sciences; Male; Medical prognosis; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Multivariate analysis; Neoplasm Metastasis; Neoplasms - therapy; Neoplasms, Second Primary - therapy; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Palliative care; Practice guidelines (Medicine); Prognosis; Prospective Studies; Rehabilitation Medicine; Palliative care; Supportive care; Chemotherapy; End of life; Prognostic score; Cancer
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-017-3680-1

Purpose A four-parameter score has been identified as associated with overall survival (OS) in patients with advanced cancer with an estimated survival inferior to 6 months. Here, we tested its prognostic value for OS in patients who had received more than two lines of systemic therapy. Methods We prospectively enrolled patients with advanced cancer who were going to receive a third or more therapeutic line outside classical clinical guidelines. The four parameters (Eastern Cooperative Oncology Group performance status, number of metastatic sites, serum LDH, and serum albumin) were collected at baseline, allowing to calculate the score, which sorted the patients in three groups, A, B, and C (low, intermediate, and high score, respectively). We then searched for correlations between this grouping and clinicopathological features particularly OS. Results From August 2013 to March 2014, 65 patients were enrolled and corresponded after determining their score to 26 patients in group A, 30 in B, and 9 in C. The median OS of the cohort was 4.4 months, and the 6-month OS was 42%. Overall survival was different between the three groups, with respective 6-month OS equal to 80% in group A, 17% in group B, and 0% in group C and respective median OS of 9, 2.3, and 1.6 months. Such prognostic value persisted in multivariate analysis. Similar OS differences were observed in patients with PS ≤2. Conclusion This simple scoring should help oncologists identify which patients, after at least two lines of systemic therapy, might benefit from best supportive care alone.