Validation of the royal marsden hospital prognostic score in patients treated in the phase I clinical trials program at the MD Anderson Cancer Center

Abstract

BACKGROUND:The authors validated the Royal Marsden Hospital (RMH) prognostic score in patients with advanced lung, pancreatic, and head and neck cancers who were enrolled on phase 1 trials in the MD Anderson Cancer Center Phase I Clinical Trials Program. METHODS: The RMH score uses albumin ( 3.5 g/dL vs <3.5 g/dL), lactate dehydrogenase (less than or equal to the upper limit of normal [ ULN] vs >ULN), and the number of metastatic sites ( 2 sites vs 3 sites) to predict patient survival in phase 1 trials. The authors of this report retrospectively reviewed the outcomes of 229 consecutive patients with lung, pancreatic, and head and neck tumors who were treated on 57 phase 1 trials. RESULTS: Two hundred twenty-nine consecutive patients with lung cancer (N ¼ 85), pancreatic cancer (N ¼ 83), and head and neck tumors (N ¼ 61) were treated. The median patient age was 60 years (range, 26-85 years), and 63% of the patients were men. Patients with a good RMH prognostic score (0-1) at baseline had a longer median survival than patients with a poor prognostic score (2-3; 33.9 weeks vs 21.1 weeks; P < .0001). The RMH score was an independent variable that predicted survival in multivariate analysis. Other independent variables that predicted better survival were hemoglobin level ( 10.5 g/dL), Eastern Cooperative Oncology Group performance status (0-1), and tumor type. Patients who were treated on first-in-human trials did not fare worse compared with those who were not treated on first-in-human trials. CONCLUSIONS: For patients with lung, pancreatic, and head and neck tumors who were treated on phase 1 trials, survival was predicted accurately by the RMH prognostic score.

Cancer Therapy Directed by Comprehensive Genomic Profiling: A Single Center Study

“…Matched and unmatched patients were well balanced for the RMH and MDACC prognostic scores (Table 1; refs. 42,46,49). The main reasons for failure to be treated include inadequate tissue for analysis and early death or worsening condition (Fig.…”

“…46,49); RMH variables plus ECOG performance status, and whether or not patients had gastrointestinal tumors are part of the MDACC score (42).…”

“…Matched versus unmatched patients were balanced for both composite prognostic scoresthe RMH score (based on levels of albumin, and LDH, and number of metastatic sites) and the MDACC scoring system (based on RMH with tumor type, and ECOG performance status as additional variables; Table 1; refs. 42,46,49). Table 2 shows that patients with direct versus indirect matches (defined in Supplementary Table S2 and Materials and Methods) had numerically better TTF and OS, while SD !6 months/PR/CR was numerically higher in the indirectly matched patients (all statistically insignificant).…”

Prognostic Factors of Survival in a Randomized Phase III Trial (MPACT) of Weekly nab-Paclitaxel Plus Gemcitabine Versus Gemcitabine Alone in Patients With Metastatic Pancreatic Cancer

“…Although toxicity data in patients aged $65 years have not been reported for the MPACT study to date, a separate analysis of dosing in the study revealed that the percentage of dose reductions in the nabpaclitaxel plus gemcitabine arm was similar regardless of age ($65 vs. ,65 years) [11]. Taken together, the findings of this analysis are particularly relevant considering that patients with these characteristics (e.g., advanced age, poor performance status, presence of liver metastasis, or more than three metastatic sites) tend to have especially poor survival outcomes [12][13][14][15].…”

The Role of Palliative Chemotherapy in Hospitalized Patients

“…The rmi has subsequently been prospectively validated at multiple institutions [22][23][24] . A variation of the rmi, developed from the same database, has also demonstrated utility with the use of hypoalbuminemia and elevated platelet count (≥400,000/mm 3 ) as a simple 2-point prognostic score 25 .…”