Oncologists seek to determine which patients may benefit from participating in a clinical trial, potentially receiving novel therapies that could prolong their life. However, identifying and placing patients with gastroesophageal (GE) cancer in clinical trials can be challenging given this cancer’s aggressive nature and the difficulty in predicting how quickly a patient may deteriorate.

A team of researchers sought to identify the best prognostic score to better predict prognosis and overall survival for patients with advanced gastric and esophageal cancer. The results of their research were published in The Oncologist.

The researchers evaluated the accuracy of 4 scoring systems for calculating prognostic risks for patients with metastatic GE cancer: Royal Marsden Hospital (RMH), MD Anderson Cancer Center (MDACC), Gustave Roussy Immune (GRIm-Score), and the MD Anderson Immune Checkpoint Inhibitor (MDA-ICI).


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For this study, prognostic risks for 451 patients with metastatic GE cancer was determined using the 4 scoringe systems. Kaplan-Meier method was used to estimate overall survival, and Cox proportional hazards models were used to analyze associations between overall survival and the prognostic scores.

The researchers found all 4 clinical prognostic scoring systems associated a high-risk designation with poor overall survival. However, the GRIm-Score had the highest predictive discrimination for overall survival and the best predictive ability for early death (within 90 days). The GRIm-Score could be used in conjunction with a clinician’s clinical judgment to identify which patients with advanced GE cancer have aggressive disease and are at risk for poor outcomes.

This information is useful to oncologists as it can inform referrals to clinical trials, as well as aid with discussing prognosis and therapeutic decision making. It could also be helpful in designing future clinical trials.

The study was limited by its nature as a retrospective study conducted at a single institution. “Our findings would require prospective validation from an independent patient cohort,” the researchers acknowledged. Future studies would also benefit from including data from more patients who were treated with HER2-targeted treatments or immune checkpoint inhibitors.

Disclosures: One author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Ma LX, Espin-Garcia O, Bach Y, et al. Comparison of four clinical prognostic scores in patients with advanced gastric and esophageal cancer. Oncologist.  Published online November 15, 2022. doi:10.1093/oncolo/oyac235