Introduction:
Whereas the EXTREME-protocol has shown significant survival outcome, many patients
in our daily practice are not fit enough and need alternative treatment regiments.
We investigated overall survival, time to treatment failure and causes of death in
patients who received palliative treatment in our clinic.
Method:
retrospective analysis.
Results:
154 patients were treated between 2010 and 2015 and 47.8% (24.8%) were alive after
12 month (24 m). Median overall survival (OS) was 11.7 m. 42 received best supportive
care (BSC), 39 EXTREME-protocol and 73 patients other systemic therapy. OS in EXTREME
was 16.1 m, BSC 2.6 m, and with other treatments 14.5 m (p < 0.001; HR BSC: 2.29;
HR other 0.9). Median time to treatment failure (TTF) under EXTREME was 6.4 m, BSC
2.5 m and with others 5.1 m (p = 0.005; HR BSC: 0.48; HR other 0.24). OS und TTF between
EXTREME and others were not stat. significant. The cause of death was in 19.2% tumor
related, in 6.6% therapy related, and in 29.8% not classified. In 44.4% cause of death
was unknown. In 2.7% death was related to EXTREME and in 3.9% related to other treatments.
Conclusion:
The results of OS and TTF that we find in a controlled setting of a clinical trial
are not always reproducible. Only part of the patients can complete the recommended
first line treatment standard of a recurrent/metastatic situation. Furthermore occurred
therapy related deaths. Our results show once more the importance of an interdisciplinary
approach and an individual selection of therapies per patient.
