Introduction

Colorectal cancer is the second most common cancer in both genders and often presents as a metastatic, unresectable, or recurrent disease in early follow-up. It is uncertain the benefit of oxaliplatin-based palliative chemotherapy (CT) in the first line of treatment in patients with compromised performance status (PS), Eastern Cooperative Oncology Group (ECOG) 3 and 4. These patients are systematically excluded from clinical trials but may be treated in clinical practice.

Methods

We conducted a prospective observational cohort whose primary outcome was improving at least 2 points in the worst symptom in the Edmonton Symptom Assessment System Scale (ESAS-r), without grade 3 to 4 toxicity, comparing baseline and fourth week of treatment. Secondary endpoints included quality of life using the European Quality of Life-5 dimensions questionnaire, toxicity, response rate, clinical improvement of ECOG PS, and overall survival (OS).

Results

We included 28 patients, and 12 (42.8%) achieved the primary endpoint. Median overall survival was 86 days, 46% of patients did not respond to the fourth-week reevaluation due to clinical deterioration, and 17.8% presented toxicity grade ≥3, with 5 patients dying from toxicity. In addition, ECOG PS 4 or cholestasis had poorer overall survival. Finally, 25% and 53.6% of patients received these treatments in the last 14 and 30 days of life, respectively.

Conclusion

In the present study, palliative multiagent chemotherapy in poor performance status patients with non-molecularly selected colorectal cancer tended to impact tumor symptoms control; however, there is no benefit in OS and a considerable risk of toxicity and treatment-related death.

中文翻译：

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姑息化疗对体力状态不佳的不可切除或转移性结直肠癌患者的影响

介绍

结直肠癌是男女中第二常见的癌症，在早期随访中通常表现为转移性、不可切除或复发性疾病。对于体能状态受损 (PS)、东部肿瘤合作组 (ECOG) 3 和 4 的患者，基于奥沙利铂的姑息化疗 (CT) 一线治疗的益处尚不确定。这些患者被系统地排除在临床试验之外，但可以在临床上进行治疗。

方法

我们进行了一项前瞻性观察队列，比较基线和治疗第四周，其主要结果是埃德蒙顿症状评估系统量表 (ESAS-r) 中最严重的症状改善至少 2 分，没有 3 至 4 级毒性。次要终点包括使用欧洲生活质量 5 维度问卷的生活质量、毒性、缓解率、ECOG PS 的临床改善和总生存期 (OS)。

结果

我们纳入了 28 名患者，其中 12 名 (42.8%) 达到了主要终点。中位总生存期为86天，46%的患者由于临床恶化而对第四周的重新评估没有反应，17.8%的患者出现≥3级的毒性，其中5名患者死于毒性。此外，ECOG PS 4 或胆汁淤积的总体生存率较差。最后，分别有 25% 和 53.6% 的患者在生命的最后 14 天和 30 天接受了这些治疗。

结论

在本研究中，对非分子选择性结直肠癌体能状态不佳的患者进行姑息性多药化疗往往会影响肿瘤症状的控制。然而，它对 OS 没有任何好处，并且存在相当大的毒性和治疗相关死亡的风险。