OnCo
ideasIdea

Dedicated cohorts for patients with performance status 2 in first-line trials

Trials usually take only patients who are up and about most of the day. Those who spend more time resting, a common group in real clinics, are excluded, so nobody knows how to treat them. A dedicated group in each trial would answer that.

First-line trials of new regimens include a pre-specified ECOG performance status 2 cohort, randomised where feasible, with safety-led dose modification, primary endpoints appropriate to the population (OS, time on treatment, QoL) and reporting in the label. Some lung cancer trials have run dedicated PS2 studies; the proposal generalises this.

Hypothesis
PS2 cohorts will show that benefit is preserved for some regimens and absent or harmful for others, information that changes real-world prescribing for a population that currently receives extrapolated care.
Rationale
PS2 patients are a sizeable share of real-world first-line recipients, especially in lung, pancreatic and upper gastrointestinal cancers, and receive full-dose regimens tested only in fitter patients.
What would test it
Require PS2 cohorts in first-line registrational trials for three cancers with high PS2 prevalence and track the resulting label statements and real-world outcomes.
Maturity
early clinical
Who has to act
industry
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks

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