Evaluating the time toxicity of cancer treatment in the CCTG CO.17 randomized clinical trial (RCT).

Authors

Arjun Gupta

Arjun Gupta

University of Minnesota Masonic Cancer Center, Minneapolis, MN

Arjun Gupta, Christopher J. O'Callaghan, Liting Zhu, Derek J. Jonker, Ralph Wong, Bruce Colwell, Malcolm J Moore, Christos Stelios Karapetis, Niall C Tebbutt, Jeremy David Shapiro, Dongsheng Tu, Christopher M. Booth

Organizations

University of Minnesota Masonic Cancer Center, Minneapolis, MN, Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada, NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada, CancerCare Manitoba, Winnepeg, MB, Canada, Dalhousie University, Halifax, NS, Canada, Princess Margaret Hospital, Toronto, ON, Canada, Flinders University, Adelaide, SA, Australia, Austin Health, Melbourne, Australia, Cabrini Health, Malvern, VIC, Australia, Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada, Queen's University, Kingston, ON, Canada

Research Funding

No funding received
None.

Background: Most individual treatments for advanced cancer are associated with modest survival benefits. The time spent in pursuing these treatments can be substantial. We have previously developed a pragmatic and patient-centered metric of these time costs, which we term ‘’time toxicity’’, as any day with physical healthcare system contact. This includes outpatient visits (e.g., for bloodwork, scans, infusions, urgent care), emergency room visits, and overnight stays in a healthcare facility. Herein we sought to assess time toxicity in a completed RCT. Methods: We conducted a secondary analysis of the Canadian Cancer Trials Group CO.17 RCT that evaluated weekly cetuximab infusions vs supportive care alone in 572 patients with advanced colorectal cancer. CO.17 recruited participants in Canada, Australia and New Zealand. Initial results reported a 6-week improvement in median overall survival (OS) with cetuximab (6.1 vs 4.6 months, p = 0.005). Subsequent analyses reported that OS benefit was restricted to and significantly more in patients with K-ras wild-type tumors. We calculated patient-level time toxicity by analyzing treatment, follow-up, and resource utilization forms. We considered a day without physical healthcare contact as a ‘’home day’’. Thus, for a patient, OS was time toxic days + home days. We compared medians of time measures across arms, and stratified results by K-ras status. Results: In the overall population, median time toxic days were higher in the cetuximab arm (28, vs 10, p < 0.001), although median home days were not statistically different (140, vs 121, p = 0.09). The proportion of time toxic days (time toxic days/OS) were significantly more with cetuximab (18%, vs 6%, p < 0.001). Of the 28 time toxic days in the overall cetuximab arm, 14 (50%) were protocol-related (e.g., scheduled infusions etc). Stratified results are in the table. Conclusions: Time toxicity can be extracted through secondary analyses of RCTs. In CO.17, despite an overall OS-benefit with cetuximab, home days were statistically similar across arms. In the K-ras-mutated group, cetuximab was associated with numerically similar OS but more time toxic days. In the K-ras-wild type group, cetuximab was associated with higher home days. Thus, time toxicity data need not always be sobering. Time toxicity measures can supplement traditional survival endpoints in RCTs to guide patient-oncologist decision-making. Cooperative group RCTs are well positioned for such analyses. Clinical trial information: NCT00079066.

Measure

(median)
CetuximabSupportive care alone
P-Value
Overall
n = 287
n = 285
 OS
6.1 months
4.6 months
0.005
 Time toxic days
28
10
< 0.001
 Home days
140
121
0.09
 % time toxic days
18%
6%
< 0.001
K-ras-mutated
n = 81
n = 83

 OS
4.5 months
4.6 months
0.089
 Time toxic days
23
11
< 0.001
 Home days
114
112
0.571
 % time toxic days
16%
8%
< 0.001
K-ras-wild type
n = 117
n = 113

 OS
9.5 months
4.8 months
< 0.001
 Time toxic days
41
10
< 0.001
 Home days
186
132
< 0.001
 % time toxic days
18%
6%
< 0.001

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Abstract Details

Meeting

2022 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Cost, Value, and Policy,Health Care Access, Equity, and Disparities,Patient Experience

Sub Track

Communication and Shared Decision-Making Research

Clinical Trial Registration Number

NCT00079066

Citation

J Clin Oncol 40, 2022 (suppl 28; abstr 248)

DOI

10.1200/JCO.2022.40.28_suppl.248

Abstract #

248

Poster Bd #

F17

Abstract Disclosures