Pretreatment PROs May Have Survival Implications in DLBCL, Finds Exploratory Study

Collecting patient-reported outcomes (PROs) from patients with diffuse large B-cell lymphoma (DLBCL) prior to the initiation of first-line treatment may help clinicians identify those who are at greater risk of not responding to treatment or having inferior survival outcomes, according to a new study.

The exploratory study captured PRO measures from over 1000 treatment-naïve patients using 4 scales—the European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30), the Functional assessment of chronic illness therapy-Lymphoma (FACT–Lym) lymphoma subscale (LYMS), global health status/quality of life (QoL), and fatigue. Across all 4 scales, pretreatment PROs were prognostic for overall (OS) and progression-free survival (PFS).

“What are the implications of the study findings for routine clinical practice?,” posed the researchers. "In looking at the results, two PRO scales in particular demonstrated consistent prognostic abilities at baseline, that is, the EORTC QLQ-C30 physical functioning and the FACT–Lym LYMS. Both provide valuable and complementary information on the impact of the disease burden from the unique patient's viewpoint. However, further analyses are needed to provide clinicians with a pragmatic PRO-based tool with clinically relevant cutoff points to identify patients at high risk of treatment failure or early relapse.”

Patient data used for the study came fromthe phase 3 GOYA study of patients receiving either obinutuzumaborrituzimab plus chemotherapy. The researchers found that the prognostic values for both OS and PFS remained (P < 0.05) even after adjusting for the International Prognostic Index (IPI), a widely used prognostic model of outcomes for the disease.

The researchers noted that while further understanding is needed to determine if PRO scales should be incorporated into IPI classification and to develop a PRO-based prognostic tool for decision making, their work paves the way for this type of research.

After adjusting for key factors in addition to IPI, including cell of origin, BCL2 mutation status, and total metabolic tumor volume, the prognostic value remained for OS (P < 0.05) but only EORTC QLQ-C30 remained significant for PFS (P < 0.05).

Based on the finding, the researchers suggest EORTC QLQ-C30 be the main PRO measure used for determining patient risk in DLBCL trials, writing, “The fact that this scale retained significance in multivariable testing speaks to the relevance and importance of these questions in a DLBCL population and suggests that if clinicians are looking for one scale that can help with prognosis, this would be the one to use. Moreover, the significance of all four scales suggests that PROs may be as important as other more objective measures, such as laboratory values and stage, in identifying patients at risk.”

The researchers also found that the scales had more prognostic value among patients with high-risk disease compared with low-risk disease. All 4 scales had significant associations with both measures of survival among patients with high-risk disease. There was no association with PFS or OS among patients with low-risk disease.

Reference

Huang H, Datye A, Fan M, et al. Patient-reported outcomes provide prognostic information for survival in patients with diffuse large B-cell lymphoma: Analysis of 1239 patients from the GOYA study. Cancer Med. Published online March 23, 2022. doi: 10.1002/cam4.4692