Background:
Prognostic information can help inform decision making. The aim of this study was to find, organise, and summarize survival data from recent RCTs in patients with AOG adenocarcinoma to help clinicians estimate and explain worst-case, typical and best-case scenarios of survival time.
Methods
We searched for RCTs of first and subsequent-line systemic therapies for patients with AOG adenocarcinoma published between 2000 to 2022. Overall survival (OS) curves were analysed and the following key percentiles (representative scenario) were extracted from each curve: 90th (worst-case), 75th (lower-typical), 25th (upper-typical), and 10th (best-case). Based on previous work we tested if simple multiples of median overall survival (mOS) could be used to estimate these percentiles: 0.25 for 90thpercentile, 0.5 for 75th, 2 for 25th, and 3 for 10th. We classified estimates ‘accurate’ if within 0.66 to 1.33 times the actual value.
Results
We identified 44 trials (n=22,447 patients), 30 first line - three immunotherapy and chemotherapy combined (CI), 27 chemotherapy with or without other therapy, 14 subsequent line – nine with chemotherapy and five with others.
For first line CI trials survival range from 4 months to not reached and other trials 3 months to 30 months and subsequent line one month to 23 months. Table 1 summarize survival scenarios. Simple multiples of mOS were accurate for estimating percentiles in majority treatment groups apart from 10thpercentiles (longer term outcomes) could not be estimated for CI trials in first line.
Conclusions
We provide personalized prognostic information presented as scenarios for survival time that are evidence-based, realistic, and can inform clinical decision-making. Simple multiples of the mOS accurately estimated the percentiles for majority groups.
Table 1:
Survival scenarios according to different treatment groups and lines
|
Treatment line and regimen |
Number of KM curves |
Number of patients |
Survival scenario in months (mean) |
||||
|
|
|
|
90th worst |
75th lower typical |
50th median |
25th upper typical |
10th best |
|
First line
|
|
16,457 |
|
|
|
|
|
|
Chemotherapy + immune checkpoint inhibitor |
3 |
1408 |
4.4 |
7.7 |
14.5 |
24.8 |
NR |
|
Chemotherapy with or without targeted therapy |
59 |
15,049 |
3.6 |
6.4 |
11 |
19 |
30 |
|
Subsequent line |
|
5990 |
|
|
|
|
|
|
Chemotherapy + antiVEGF |
1 |
330 |
3 |
5 |
9.5 |
15.2 |
22.5 |
|
Chemotherapy |
14 |
4044 |
2.4 |
4.2 |
7.4 |
12.8 |
21.3 |
|
Immunotherapy |
3 |
711 |
1.4 |
2.8 |
6.4 |
13.6 |
22.1 |
|
TKI |
1 |
238 |
1.3 |
2.4 |
5.1 |
9.8 |
17.3 |
|
Best supportive care |
4 |
667 |
1.1 |
2 |
3.9 |
7.9 |
13.1 |
*TKI (Tyrosine Kinase Inhibitors)
*VEGF (Vascular Endothelial Growth Factor)
NR (not reached)
KM (Kaplan Meier curve)