Estimating 12-week death probability in patients with refractory metastatic colorectal cancer: the Colon Life nomogram

Abstract

Our nomogram may be a useful tool to predict the probability of death within 12 weeks in patients with refractory mCRC. Based on four easy-to-collect variables, the 'Colon Life' nomogram and free app for smartphones may improve mCRC patients' selection for later-line therapies and assist researchers for the enrollment in clinical trials in this setting.

Trifluridine/Tipiracil (TAS-102) in Refractory Metastatic Colorectal Cancer: A Multicenter Register in the Frame of the Italian Compassionate Use Program

“…To this end, we compared the clinical and molecular characteristics of patients who were or were not progression free at 6 months and found significant differences in terms of ECOG PS, LDH levels, prior resection of the primary tumor, and time from the diagnosis of metastatic disease (<18 months vs. >18 months). These variables coincide, with the exception of the time from the diagnosis of metastatic disease, with those previously identified in a clinical nomogram, ColonLife, built to predict the probability of death within 12 weeks in heavily pretreated patients with mCRC . The discriminative ability of the nomogram, applied to the present series by using information collected before the beginning of the treatment with TAS‐102, was confirmed, thus corroborating the effectiveness of this prognostic tool for a population homogeneously treated with TAS‐102.…”

“…In the absence of validated predictive factors, the selection of candidate patients may rely on an accurate prognostic assessment, including ECOG PS, LDH levels, and time from the diagnosis of metastatic disease. The reliability of the ColonLife nomogram in predicting the 12‐week life expectancy is further confirmed . Although excluding patients with a very short life expectancy from receiving further treatments seems reasonable, the role of the nomogram as predictor of benefit from TAS‐102 should be evaluated in post hoc analyses of randomized trials.…”

“…At the same time, as observed in a previous validation cohort, the early mortality of patients treated with TAS‐102 was lower than predicted by the ColonLife variables, thus indirectly confirming the efficacy of the drug in prolonging survival. The lack of a control group of untreated patients prevented drawing any conclusion about the potential predictive ability of the ColonLife nomogram or of other clinical or molecular factors that should be properly investigated in randomized trials . However, even if the nomogram does not permit identifying an individual patient who should not be treated with later‐line options, it is clinically arguable that refractory patients with a very low probability of being alive after 12 weeks may benefit less from any further treatment, including TAS‐102, so that in these cases the cost‐efficacy balance of available therapies should be carefully weighed.…”

“…Finally, the “ColonLife” nomogram was recently built to predict the probability of death within 12 weeks of patients with refractory mCRC, based on four easy‐to‐collect clinical variables: Eastern Cooperative Oncology Group performance status (ECOG PS), primary tumor resection, lactate dehydrogenase (LDH) levels, and peritoneal metastases. The nomogram was built and validated in a heterogeneous series that included refractory patients treated with regorafenib, TAS‐102, or other systemic treatments . Data from patients homogeneously treated with TAS‐102 in the compassionate use program allowed us to further validate the nomogram and to corroborate its usefulness as a potential tool to select patients with refractory mCRC with the chance of meaningful benefit from this new option.…”

Estimating Survival Probabilities of Advanced Gastric Cancer Patients in the Second-Line Setting: The Gastric Life Nomogram

“…Therefore, some questions are arising: can we predict a relatively short-term life expectancy (i.e., 3 or 6 months) at the beginning of second-line treatment in order to potentially assign individual patients to best supportive care versus active treatment or to treatment sequences versus the potentially last treatment line? As already shown in refractory metastatic colorectal cancer [28], prognostic tools such as nomograms may assist clinicians in accurately assessing their patients' life expectancy by means of easy-to-collect clinical or pathological variables, therefore providing an objective information able to usefully support the subjective experience. In the Gastric Life nomogram, three variables (ECOG PS, N/L ratio, and peritoneal involvement) are able to predict the 3-and 6-month OS probability in mGC patients deemed eligible for second-line therapy.…”