Andrew J Martin1, Emma Gibbs2, Katrin Sjoquist2,3, Nick Pavlakis4,5, John Simes2,4, Tim Price4,6, Jenny Shannon4,7, Sanjeev Gill8, Vikram Jain9, Geoffrey Liu10, George Kannourakis11,12, Yeul Hong Kim13, Jin Won Kim14, David Goldstein4,15. 1. NHMRC Clinical Trials Centre University of Sydney, Locked Bag 77, Camperdown, NSW, 1450, Australia. andrew.martin@ctc.usyd.edu.au. 2. NHMRC Clinical Trials Centre University of Sydney, Locked Bag 77, Camperdown, NSW, 1450, Australia. 3. Cancer Care Centre, St George Hospital, Kogarah, Australia. 4. Australasian Gastro-Intestinal Trials Group, Camperdown, Australia. 5. Royal North Shore Hospital, University of Sydney, St Leonards, Australia. 6. The Queen Elizabeth Hospital, Woodville, Australia. 7. Nepean Hospital Cancer Care Centre, Kingswood, Australia. 8. The Alfred Hospital, Melbourne, Australia. 9. ICON Cancercare, South Brisbane, Australia. 10. University Health Network, Princess Margaret Hospital, Toronto, Canada. 11. Ballarat Oncology and Haematology Services, Wendouree, Australia. 12. Fiona Elsey Cancer Research Institute, Ballarat, Australia. 13. Korea University Anam Hospital, Seoul, South Korea. 14. Seoul National University Bundang Hospital, Seongnam, South Korea. 15. Prince of Wales Hospital, Randwick, Australia.
Abstract
BACKGROUND: The INTEGRATE phase II multinational randomized controlled trial demonstrated the activity of regorafenib on progression-free survival (PFS) in patients with refractory advanced gastric adenocarcinoma. We sought to evaluate whether these PFS gains had the potential to be offset by quality of life (QoL) impacts from treatment side effects and to thereby determine the appropriateness of continuing development to phase III. METHODS:QoL was assessed in INTEGRATE at baseline and at each 4 weeks thereafter, until discontinuation of study treatment, using the QLQ-C30, STO22, and EQ-5D questionnaires. The patient disease and treatment assessment (PTDATA) form was also provided to English-speaking participants. Randomized groups were compared on the QLQ-C30, STO22, and EQ-5D scales using a repeated-measures model; the frequency of troublesome symptoms and side effects measured by the PTDATA form; and deterioration-free survival (DFS). The prognostic value of baseline QoL information was also evaluated. RESULTS: Of the 147 eligible randomized patients, 142 consented to participate in the QoL substudy, 136 completed a baseline QoL assessment, and 95 completed at least one post-baseline QoL assessment. The DFS rate was significantly improved with regorafenib, and there was no compelling statistical evidence that regorafenib had a broad negative effect across the spectrum of QoL indices evaluated. Fatigue, anxiety, appetite loss, and pain were among the issues most commonly reported for both randomized groups. Baseline levels of pain, appetite, constipation, and physical functioning were prognostic factors for survival. CONCLUSIONS:Regorafenib improved DFS without an excessively negative effect on QoL. Progressing development to the phase III setting is warranted.
RCT Entities:
BACKGROUND: The INTEGRATE phase II multinational randomized controlled trial demonstrated the activity of regorafenib on progression-free survival (PFS) in patients with refractory advanced gastric adenocarcinoma. We sought to evaluate whether these PFS gains had the potential to be offset by quality of life (QoL) impacts from treatment side effects and to thereby determine the appropriateness of continuing development to phase III. METHODS: QoL was assessed in INTEGRATE at baseline and at each 4 weeks thereafter, until discontinuation of study treatment, using the QLQ-C30, STO22, and EQ-5D questionnaires. The patient disease and treatment assessment (PTDATA) form was also provided to English-speaking participants. Randomized groups were compared on the QLQ-C30, STO22, and EQ-5D scales using a repeated-measures model; the frequency of troublesome symptoms and side effects measured by the PTDATA form; and deterioration-free survival (DFS). The prognostic value of baseline QoL information was also evaluated. RESULTS: Of the 147 eligible randomized patients, 142 consented to participate in the QoL substudy, 136 completed a baseline QoL assessment, and 95 completed at least one post-baseline QoL assessment. The DFS rate was significantly improved with regorafenib, and there was no compelling statistical evidence that regorafenib had a broad negative effect across the spectrum of QoL indices evaluated. Fatigue, anxiety, appetite loss, and pain were among the issues most commonly reported for both randomized groups. Baseline levels of pain, appetite, constipation, and physical functioning were prognostic factors for survival. CONCLUSIONS:Regorafenib improved DFS without an excessively negative effect on QoL. Progressing development to the phase III setting is warranted.
Entities:
Keywords:
Antineoplastic agents/therapeutic use; Protein kinase inhibitors/therapeutic use; Quality of life; Stomach neoplasms
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