Patient-reported outcomes and health-related quality of life for cetuximab versus bevacizumab in metastatic colorectal cancer: a prospective cohort study

Uncertainty exists regarding Patient-Reported Outcomes (PROs) and Health-Related Quality of Life (HRQoL) of patients with metastatic colorectal cancer (mCRC) treated with cetuximab or bevacizumab. We conducted a prospective cohort study comparing PROs and HRQoL from both therapies. This study included 44 patients treated for the first time with one of the strategies, whose PROs scoring for internationally validated questionnaires were compared at three sequential timepoints: baseline, 6-week, and 12-week assessments. Overall Treatment Utility (OTU), an outcome derived from clinical (time to treatment faillure) and patient-reported outcomes was also determined for the same timepoints. We observed that cetuximab-containing regimens led to a progressive, and clinically meaningful, negative impact on PROs and global HRQoL, when compared to baseline and bevacizumab. OTU was also higher for bevacizumab across all timepoints. 

Authors and Affiliations:
Rui Pedro Marques^1,2,  Peter Heudtlass³, Helena Luna Pais², António Quintela², Ana Paula Martins¹

¹ Research Institute of Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa;

² Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN);

³ Centre for Health Evaluation and Research (CEFAR), Portuguese Pharmacy Association (ANF).

Abstract:

Uncertainty exists regarding Patient-Reported Outcomes (PROs) and Health-Related Quality of Life (HRQoL) of patients with metastatic colorectal cancer (mCRC) treated with cetuximab or bevacizumab. We conducted a prospective cohort study comparing PROs and HRQoL from both therapies. We assessed PROs and HRQoL from patients treated with cetuximab or bevacizumab using QLQ-C30 and QLQCR29 questionnaires at three sequential time points, including baseline. Global Health Status (GHS), functional and symptom scales, and Overall Treatment Utility (derived from clinical and patient-reported outcomes) were compared for the two treatment strategies. Between January 2017 and April 2018, 44 patients were allocated to cetuximab (n = 19) or bevacizumab (n = 25). Except for RAS mutation status, patient baseline characteristics were generally well balanced across treatment groups. A higher proportion of patients experienced a deterioration in GHS (≥ 10%) in cetuximab arm − 53.8% (95% CI 25.1–80.8%) at 6 weeks and 66.7% (95% CI 29.9–92.5%) at 12 weeks—comparing to bevacizumab cohort: 18.2% (95% CI 5.2–40.3%) at 6 weeks and 12.5% (95% CI:1.6–38.3%) at 12 weeks. Treatment utility rates at 6 and 12 weeks were, respectively, 88.6% and 69.8% for bevacizumab, compared to 49% and 19.1% for cetuximab (p = 0.004), a difference confirmed in subset analyses. In patients with mCRC, cetuximab-containing regimens led to a progressive negative impact on PROs and global HRQoL, when compared to baseline and bevacizumab. Future research is needed to confirm these results. Our findings demonstrate the value of PROs when assessing comparative effectiveness of different treatment regimens.

Journal: Journal of Cancer Research and Clinical Oncology

Link: https://link.springer.com/article/10.1007%2Fs00432-019-02924-0