Baktiar Hasan1, Laurent Greillier2, Athanasios Pallis3, Jessica Menis3, Rabab Gaafar4, Richard Sylvester3, Dean A Fennell5, Paul Baas6, Veerle Surmont7, Jan P Van Meerbeeck8, Mary E R O'brien9. 1. European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium. Electronic address: baktiar.hasan@eortc.be. 2. Assistance Publique - Hôpitaux de Marseille, Aix Marseille University, Marseille, France. 3. European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium. 4. National Cancer Institute, Cairo University, Cairo, Egypt. 5. University of Leicester, Hodgkin Building, Leicester, United Kingdom. 6. Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands. 7. Ghent University, Gent, Belgium. 8. Ghent University and Antwerp University Hospital, Belgium. 9. The Royal Marsden Hospital, Sutton, United Kingdom.
Abstract
BACKGROUND: Response criteria have always been difficult to apply to malignant pleural mesothelioma (MPM), due to its unique pattern of growth. We developed some models to show that progression free survival rate (PFSR) could be a better predictor of overall survival (OS) than the response rate (RR) in MPM patients. The results were validated independently in the European Organisation for Research and Treatment of Cancer (EORTC) 08052, a phase II study in MPM. METHODS: Individual patient data from 10 EORTC-Lung Cancer Group (LCG) studies of first-line chemotherapy in MPM were pooled. Response to therapy was assessed according to World Health Organisation (WHO) criteria in all except the two most recent trials, which used Response Evaluation Criteria in Solid Tumours (RECIST). Landmark analyses (LA) at 9 weeks and 18 weeks after registration/randomisation were performed to assess the association between PFSR and OS. Independent validation of the results was conducted in EORTC 08052 study (82 patients) employing the same LA. RESULTS: All 10 studies (N=523 patients) were included in the LA of PFSR at 9 and 18 weeks (PFSR-9 and PFSR-18). PFSR-9 and PFSR-18 were confirmed as predictors of OS, with hazard ratio (HR) of 0.37 (95% confidence interval (CI), 0.30-0.47) and 0.50 (0.38-0.65) and C-index of 0.62 and 0.58, respectively. In the validation study, 28.4% achieved CR/PR and 77.8% had disease control (CR/PR/SD) as their best overall response. PFSR-9 and PFSR-18 weeks were both strongly correlated with OS (HR of 0.35 [80% CI, 0.25-0.49] and 0.46 (0.32-0.67) and C-index of 0.66 and 0.60, respectively). CONCLUSION: PFSR-18 was strongly correlated and discriminated patients with better OS from the poorer prognosis patients. An earlier end-point, PFSR-9 was also strongly correlated to OS with better discriminating capacity. The results were independently validated.
BACKGROUND: Response criteria have always been difficult to apply to malignant pleural mesothelioma (MPM), due to its unique pattern of growth. We developed some models to show that progression free survival rate (PFSR) could be a better predictor of overall survival (OS) than the response rate (RR) in MPM patients. The results were validated independently in the European Organisation for Research and Treatment of Cancer (EORTC) 08052, a phase II study in MPM. METHODS: Individual patient data from 10 EORTC-Lung Cancer Group (LCG) studies of first-line chemotherapy in MPM were pooled. Response to therapy was assessed according to World Health Organisation (WHO) criteria in all except the two most recent trials, which used Response Evaluation Criteria in Solid Tumours (RECIST). Landmark analyses (LA) at 9 weeks and 18 weeks after registration/randomisation were performed to assess the association between PFSR and OS. Independent validation of the results was conducted in EORTC 08052 study (82 patients) employing the same LA. RESULTS: All 10 studies (N=523 patients) were included in the LA of PFSR at 9 and 18 weeks (PFSR-9 and PFSR-18). PFSR-9 and PFSR-18 were confirmed as predictors of OS, with hazard ratio (HR) of 0.37 (95% confidence interval (CI), 0.30-0.47) and 0.50 (0.38-0.65) and C-index of 0.62 and 0.58, respectively. In the validation study, 28.4% achieved CR/PR and 77.8% had disease control (CR/PR/SD) as their best overall response. PFSR-9 and PFSR-18 weeks were both strongly correlated with OS (HR of 0.35 [80% CI, 0.25-0.49] and 0.46 (0.32-0.67) and C-index of 0.66 and 0.60, respectively). CONCLUSION: PFSR-18 was strongly correlated and discriminated patients with better OS from the poorer prognosis patients. An earlier end-point, PFSR-9 was also strongly correlated to OS with better discriminating capacity. The results were independently validated.
Authors: Mir Alireza Hoda; Thomas Klikovits; Madeleine Arns; Karin Dieckmann; Sabine Zöchbauer-Müller; Christian Geltner; Bernhard Baumgartner; Peter Errhalt; Barbara Machan; Wolfgang Pohl; Jörg Hutter; Josef Eckmayr; Michael Studnicka; Martin Flicker; Peter Cerkl; Walter Klepetko Journal: Wien Klin Wochenschr Date: 2016-07-25 Impact factor: 1.704