Time to Definitive Health-Related Quality of Life Score Deterioration in Patients with Resectable Metastatic Colorectal Cancer Treated with FOLFOX4 versus Sequential Dose-Dense FOLFOX7 followed by FOLFIRI: The MIROX Randomized Phase III Trial

Abstract

Purpose: We previously showed that a sequential chemotherapy with dose-dense oxaliplatin (FOLFOX7) and irinotecan (FOLFIRI; irinotecan plus 5-fluorouracil/leucovorin) is not superior to FOLFOX4 in patients at advanced stage of colorectal cancer with liver metastases. Here we aimed to determine whether time to health-related quality of life (HRQoL) score definitive deterioration (TUDD) differs by study arm.

Methods: HRQoL was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 at baseline and every 4 cycles until the end of the study or death. Functional scale, symptom scale, global health status, and financial difficulties were analyzed. The TUDD was defined as the time interval between randomization and the first decrease in HRQoL score ≥ 5-point with no further improvement in HRQoL score ≥ 5 points or any further HRQoL data. TUDD was estimated using the Kaplan-Meier method and the long-rank test. Cox regression analyses were used to identify HRQoL items influencing TUDD. Sensitivity analyses were done using a multiple imputation method and different definitions of TUDD.

Results: Of the 284 patients, 171 (60.2%) completed HRQoL questionnaires. Cox multivariate analysis showed no statistically significant difference in TUDD for most of the QLQ-C30 scales between treatments. Patients with dyspnea and those without symptoms at baseline had a significantly longer TUDD when there was a delay >12 months between diagnosis of the primary tumor and metastases (HR 0.48 [0.26-0.89]) and when there was diarrhea (HR 0.59 [0.36-0.96]), respectively.

Conclusion: This study shows that TUDD does not differ significantly according to type of treatment. The TUDD method produces meaningful longitudinal HRQoL results that may facilitate effective clinical decision making in patients with mCRC.

Trial registration: ClinicalTrials.gov NCT00268398.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. CONSORT Diagram for health-related quality of life analysis.

Fig 2. Forest plots showing hazard ratios obtained by univariate Cox regression analysis of TUDD for EORTC QLQ-C30 scales according to treatment arm.

Fig 3. Kaplan-Meier survival curves for TUDD according to global health status (A), physical functioning (B), role functioning (C), emotional functioning (D), cognitive functioning (E), social functioning (F) fatigue (G), nausea (H), pain (I), dyspnea (J), insomnia (K), appetite loss (L), constipation (M), and diarrhea (N).

Fig 4. Forest plots showing hazard ratios obtained by multivariate Cox regression analysis of TUDD for EORTC QLQ-C30 scales according to treatment arm.

Fig 5. Forest plots showing hazard ratios obtained by multivariate Cox regression analysis of TUDD (excluding death as event) for EORTC QLQ-C30 scales according to treatment arm.