Performance status as prognostic factor in phase III trials of first‐line chemotherapy of unresectable or metastatic pancreatic cancer: A trial‐level meta‐analysis. Issue 3 (23rd June 2021)

• Record Type: Journal Article
• Authors: Colloca, Giuseppe
• Is Part Of: Asia-Pacific journal of clinical oncology. Volume 18:Issue 3(2022)
• Page Start: 232
• Page End: 239
• Publication Date: 2021-06-23
• Subjects: chemotherapy -- pancreatic cancer -- performance status -- prognosis; Oncology -- Pacific Area -- Periodicals; Cancer -- Treatment -- Pacific Area -- Periodicals; Cancer -- Pacific Area -- Periodicals; Cancer -- Treatment -- Periodicals; 616.9940095
• DOI: 10.1111/ajco.13598
• Languages: English
• ISSNs: 1743-7555

Abstract

Abstract: For patients with unresectable or metastatic pancreatic adenocarcinoma (mPDAC), there are no standardized prognostic and predictive factors beyond performance status (PS). A poor PS, as defined by Eastern Cooperative Oncology Group (ECOG) score of 2 or more, has been related with a detrimental effect of chemotherapy. Therefore, even more trials enrolled patients with good PS. The current analysis aims to evaluate the results of PS as a prognostic factor in phase III trials of patients with mPDAC receiving first‐line chemotherapy. A literature search on two databases, from 2000 to 2019, and a further selection of clinical trials were performed by predefined criteria. Twelve phase III studies have been included in the analysis: the trials, enrolling 5619 patients, confirmed the worse prognosis of patients with higher ECOG PS scores (hazard ratio [HR] = 1.45; 95% confidence interval [CI], 1.21–1.74; p ‐value < 0.001), and a similar trend was evident for patients with an ECOG PS 1 versus 0 (HR = 1.61; 95% CI, 1.43–1.80; p ‐value < 0.001) in six studies, enrolling 2799 patients. Heterogeneity of trials was high, with I 2 = 91%. Some possible moderators have been suggested, such as the number of drugs in the chemotherapy regimen and the male gender. In conclusion, a low ECOG PS score appears to be related with a longer survival even in trials that excluded patients with an ECOG PS 2 score, but the meta‐analyses reported high heterogeneity and publication bias.