Nomogram for predicting overall survival (OS) in patients (pts) treated with nab-paclitaxel (nab-P) plus gemcitabine (Gem) or Gem alone for metastatic pancreatic cancer (MPC).

Authors

null

David Goldstein

Prince of Wales Hospital, University of New South Wales, Cancer Survivors Centre, Sydney, Australia

David Goldstein , Daniel D. Von Hoff , E. Gabriela Chiorean , Michele Reni , Josep Tabernero , Ramesh K. Ramanathan , Abdalla Aly , Marc Botteman , Julia Wilkersen , Sandra Margunato-Debay , Brian Lu , Chrystal Ursula Louis , Markus Frederic Renschler , Desmond Micahel Thomas McGovern , Chee Khoon Lee

Organizations

Prince of Wales Hospital, University of New South Wales, Cancer Survivors Centre, Sydney, Australia, Translational Genomics Research Institute (TGen) and HonorHealth, Phoenix, AZ, Fred Hutchinson Cancer Research Center, Seattle, WA, Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy, Vall d’Hebron University Hospital Institute of Oncology (VHIO), Barcelona, Spain, Mayo Clinic Cancer Center, Phoenix, AZ, Pharmerit International, Bethesda, MD, Pharmerit, Bethesda, MD, Celgene Corporation, Summit, NJ, Merrimack Pharmaceuticals, Inc., Cambridge, MA, Celgene Europe Limited, Uxbridge, United Kingdom, St George Hospital, Sydney, Australia

Research Funding

Pharmaceutical/Biotech Company

Background: Prognostic nomograms have been developed in various cancers, including ovarian, breast, and gastrointestinal; however, there is limited information on nomograms in MPC. The large, phase 3 MPACT study of nab-P + Gem vs Gem alone for the treatment of MPC provides a robust database for the development of a nomogram to predict OS using baseline patient variables. Methods: A multivariable Cox model was created from MPACT data using factors that were significantly predictive of OS in univariable analysis or considered clinically important (stepwise selection to remain in model). From the Cox model, a nomogram was derived that assigned points equal to the weighted sum of relative significance of each variable. The nomogram was internally validated using bootstrapping, a concordance index (c-index), and calibration plots. Results: Data from all 861 pts were used. Seven of the 34 considered variables were retained in the multivariable analysis (Table; all factors significant at the P< 0.01 level, except for analgesic use [P = 0.07]). The resulting nomogram was able to distinguish low (n = 216), medium (n = 430), and high (n = 215) risk groups (c-index: 0.69; CI: 0.67-0.71) with median OS values of 12.9, 8.2, and 3.7 months, respectively. Calibration curves showed that the nomogram’s predicted probabilities were mostly consistent with observed probabilities for 6-, 9-, and 12-month OS. Conclusions: Treatment arm, Karnofsky performance status (KPS), neutrophil-to-lymphocyte ratio (NLR), albumin level, sum of longest tumor diameters (SLD), and presence of liver metastasis were the key predictors of OS. This nomogram, which will be presented in visual format in the final presentation, may help physicians and pts make informed treatment decisions. Clinical trial information: NCT00844649

Multivariable cox model for OS.

VariableaHRCI
Treatment arm1.561.34-1.82
NLR1.051.04-1.07
Albumin0.940.92-0.95
KPS (per 10-unit increase)0.970.96-0.98
SLD1.021.01-1.03
Presence of liver metastasis1.621.29-2.03
Analgesic use1.160.99-1.36

a Results similar in a sensitivity analysis that excluded CA19-9 non-secretors

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal (Noncolorectal) Cancer

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Pancreatic Cancer

Clinical Trial Registration Number

NCT00844649

Citation

J Clin Oncol 35, 2017 (suppl; abstr 4109)

DOI

10.1200/JCO.2017.35.15_suppl.4109

Abstract #

4109

Poster Bd #

101

Abstract Disclosures