Quality-of-life (QoL) as a predictive biomarker in patients with advanced pancreatic cancer (APC) receiving chemotherapy: results from a prospective multicenter phase 2 trial

Abstract

Purpose: Pancreatic cancer is rapidly fatal with median survival of only 6 months (mo). Quality-of-life (QoL) was analyzed prospectively in a phase 2 study of gemcitabine (G), capecitabine (C) and bevacizumab (B) in APC patients.

Methods: A total of 50 patients with APC received B 15 mg/kg, C 1,300 mg/m(2) daily for 2 weeks and G 1,000 mg/m(2) weekly 2 times; cycles were repeated every 21 days.

Endpoints: progression free survival (PFS), overall survival (OS) and assessment of QoL prior to each cycle using the European organization for research and treatment of cancer (EORTC) PAN-26 QoL questionnaire. An exact 95% confidence interval (CI) (Clopper-Pearson method) was used to assess rate of improved QoL (defined as >5% decrease in two consecutive scores compared with baseline).

Results: Patient characteristics- Stage IIB/III/IV: 3/5/42; Sex: 28 M/22 F; Median age: 64 years. QoL in patients- improved: 56%, no improvement: 24%; unevaluable: 20%. Median PFS: 5.8 mo, OS: 9.8 mo. QoL improvement rate: 28/40=0.7 (95% CI: 0.53-0.83) in evaluable patients. Using QoL improvement rate, no significant difference was seen in patients with OS ≥6 mo compared to OS <6 mo. However QoL scores at 3 and 6 weeks from start of treatment correlated strongly with ≥6 mo survival (P value 0.0092 and 0.0081, respectively).

Conclusions: Baseline score and change in QoL scores of patients on G, C and B were not predictive of survival ≥6 mo. Post treatment scores at 3 and 6 weeks from start of therapy however, were predictive of survival ≥6 mo suggesting the potential predictive value of this tool for use in future studies.

Keywords: Quality of life (QoL); biomarkers; neoplasm, European organization for research and treatment of cancer (EORTC); outcomes; palliative care; pancreas; pancreatic cancer; supportive oncology.

Figure 1

(A) Progression free survival (PFS) curve. Unimproved (black), improved (red); (B) Overall survival (OS) curve. Unimproved (black), improved (red).

Figure 2

Quality-of-life (QoL) plot. At baseline (time 0): progressive disease (PD) (green) represents 5 pts, and complete response (CR) + partial response (PR) + stable disease (SD) (blue) represents 41 pts, total of 46 pts data. Vertical lines for each point indicate standard deviation. For Green, the last point (at 2) has only 2 pts. For Blue, the last point (at 10) has about 10 pts data. Average days between surveys are 22.5 days.

Figure 3

A Quality-of-life (QoL) scores at visit 1 (initial day of treatment); (B) QoL scores at visit 2 (3 weeks into treatment); (C) QoL scores at visit 3 (6 weeks into treatment).