AT A GLANCE

A new study published in the Journal of Clinical Oncology suggests that the same prognostic model using practical variables can be used before all treatment lines in patients with metastatic colorectal cancer.¹

"Several lines of treatment can be used sequentially in patients with metastatic colorectal cancer," explain study authors Bachet et al. Using patient data from 48 randomized trials, the authors investigated "the evolution of patient/tumor characteristics and their prognostic impact across treatment lines to develop an overall prognostic score (OPS)."

According to the authors, the endpoint of interest was overall survival (from random assignment to death). Missing data were imputed, and the complete data set was then separated into construction (80%) and validation sets (20%). Cox's modeling was used to define risk groups for survival using the OPS. Separately, they add, the discrimination capability was assessed in each treatment-line via bootstrapping to obtain optimism-corrected calibration and discrimination C-indices. Internal validation was performed in the validation set.

Ultimately, 37,560 patients (26,974 first-line [1L], 7,693 second-line [2L], and 2,893 third-line [3L]) were analyzed.

"Some clinical, biological, and molecular characteristics of patients/tumors included in therapeutic trials evolve over the lines," the authors note. A total of seven independent prognostic variables were retained in the final multivariate model common to all lines, including the Eastern Cooperative Oncology Group performance status, hemoglobin, platelet count, ratio of white blood cells to absolute neutrophil count, lactate dehydrogenase, alkaline phosphatase, and the number of metastatic sites.

Four patient subgroups with significantly different prognoses were defined using the OPS separately in the 1L, 2L, and 3L groups, with adequate C-indices: 0.65, 0.66, and 0.69 in the construction set and 0.65, 0.66, and 0.68 in the validation set, respectively. Ultimately, however, the OPS was not predictive, with 3L drugs (versus placebo) or subsequent-line drugs (2L/1L or 3L/2L) extending survival in all prognostic groups.

"The same prognostic model using practical variables can be used before all treatment lines. The OPS could better stratify patients in future clinical trials and help to therapeutic decision in routine practice," conclude the authors.

Reference

1. Bachet J-B, de Gramont A, Raeisi M, et al. Characteristics of patients and prognostic factors across treatment lines in metastatic colorectal cancer: an analysis from the Aide et Recherche en Cancérologie Digestive Database. J Clin Oncol.2025:JCO2401968.