Abstract PO-029: Using treatment to determine ECOG performance status in metastatic pancreatic cancer
Authors: Amin Suvina , Malangone-Monaco Elisabetta , Noxon Virginia , Joo Seongiung , Pishvaian Michael J. 
Published: November 2020

Abstract
Aim: ECOG Performance status (PS) is a major prognostic factor in patients with metastatic pancreatic cancer (mPAC) and is one of key factors to consider in treatment selection. However, there is limited ability to determine PS through administrative claims. We aimed to establish PS based on first-line (1L) treatment to describe characteristics of mPaC patients in a claims database. Methods: The IBM MarketScan database was used to identify adult, treated mPaC patients from 2014-2018. Those with other primary cancers or pregnant during the study, chemotherapy in the 6 month pre-diagnosis (baseline) period prior to first mPaC diagnosis or those without continuous enrollment in this time were excluded. PS was assumed by NCCN guideline-recommended first-line treatment for PS. Those with first-line FOLFIRINOX or gemcitabine + nab-paclitaxel were good performers. Those with first-line gemcitabine monotherapy or gemcitabine + (capecitabine or erlotinib) were poor performers. Patients with any other first-line treatment were ungrouped. Patient characteristics were measured in the 6-month baseline period or at mPaC diagnosis. Treatment patterns were measured during the variable length follow-up which ended due to disenrollment or end of study (12/31/2018). Results: A total of 1,737 mPaC patients met all inclusion criteria, of which 59.6% were categorized as good performers and 11.6% as poor performers. Poor PS was mainly identified by gemcitabine monotherapy (99.5%) while good PS was split between gemcitabine+nab-paclitaxel (54.9%) and FOLFIRINOX (45.1%). Patients were mostly male (56.0%) with a median follow-up of 202 days and no difference by PS. Poor performers (vs. good) were significantly older (mean age 67.5 vs 61.1 years, p&lt;0.0001) and had a significantly (p&lt;0.01) higher baseline National Cancer Institute Adapted Charlson Comorbidity (NCI-CCI) score (1.1 vs 0.7), influenced by myocardial infarction (5.4% vs 1.6%) and chronic renal disease (7.9% vs 3.5%). Poor performers (vs. good) had a significantly (p&lt;0.01) higher rate of gastric outlet obstruction (3.0% vs 0.2%), pancreatectomies (5.4% vs 0.8%), and cancer related procedures (21.8% vs 13.8%) during baseline. Poor performers (vs good) had a noticeably smaller proportion with second-line therapy (43.6% vs 62.5%). Conclusions: Using first-line treatment to assume PS grouped most patients in our study as good performers. Patient characteristics reflect expected differences in PS (poor performers have more comorbidities and are older) and treatment prescribing patterns may provide a way to assume PS in the absence of PS data in administrative claims. Further studies to validate PS predictors using observed treatment regimens in claims is needed to further explore the underlying differences driving outcomes.
Citation Format: Suvina Amin, Elisabetta Malangone-Monaco, Virginia Noxon, Seongiung Joo, Michael J. Pishvaian. Using treatment to determine ECOG performance status in metastatic pancreatic cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2020 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2020;80(22 Suppl):Abstract nr PO-029.