Abstract
Background
The management of metastatic colorectal cancer patients with a poor performance status
(PS) continues to be a clinical dilemma, with the potential activity and safety of
treating this population remaining poorly understood. Few of these patients are enrolled
onto clinical trials, and poor PS is often multifactorial.
Patients and Methods
We analyzed the Treatment of Recurrent and Advanced Colorectal Cancer registry to
describe treatment practices and outcomes in poor (Eastern Cooperative Oncology Group
[ECOG] PS 2) and very poor PS (ECOG PS > 2) patients to explore the relationship between
age, tumor burden, comorbidities, and PS, and to evaluate the benefit of systemic
therapy. Standard descriptive statistical methods, Kaplan-Meier analysis, and a multivariate
Cox regression model were used.
Results
Of 2769 registry patients (diagnosed January 2009 to June 2018), 329 (12%) and 182
(7%) patients had a poor and very poor PS, respectively. Good PS patients were more
likely to receive systemic therapy than poor and very poor PS patients (85%, 55%,
and 21.5%, P < .0001), but clinician assessed response was observed in all subsets (53%, 41%,
and 29%, P = .0003). Treatment with chemotherapy was associated with longer median overall survival
across PS groups. Exploratory analysis based on comorbidity score and tumor burden
subgroups demonstrated a consistently positive overall survival association with treatment.
Benefit was observed where poor overall survival was attributable to medical comorbidities
and to tumor burden.
Conclusion
In routine clinical care, a substantial proportion of poor and very poor PS patients
receive active treatment, which is often associated with meaningful clinical benefit.
Keywords
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Article info
Publication history
Published online: August 12, 2020
Accepted:
August 9,
2020
Received in revised form:
August 5,
2020
Received:
June 18,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
