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CD 1, Track 18

DR LOVE: Mark, can you discuss how you approach patients who have a poor performance status and metastatic disease?

DR SOCINSKI: We all see patients with poor performance status who three months earlier were playing 18 holes of golf. They became sick because they developed cancer — they had no comorbidities.

I tend to be more aggressive with those patients than with the other group of patients, who were on oxygen two years ago and have an ejection fraction of 25 percent. Those patients aren’t going to get much better with chemotherapy. So I take a different approach and tend to use single agents.

For the first group of patients, for whom I believe the performance status is pushed by the cancer, I trust the CALGB (Lilenbaum 2005) and Rogerio’s data (Lilenbaum 2006), and I believe that two drugs are better than one in that setting.

DR LOVE: Rogerio, how do you approach the patient with a performance status of two because of either the tumor or nononcologic morbidities?

DR LILENBAUM: This is something we’ve discussed for a while now, since the CALGB study was presented. Intuitively, you would like to approach these two subsets of patients a little differently. Yet we have no prospective data or validation that this is the best practice.

A patient who was relatively healthy three or four months ago and now has rampant disease-related symptoms and a rapidly declining performance status should receive combination chemotherapy. With patients who have had a borderline functional status, comorbidities, et cetera, and the impact of the cancer on their overall performance status is either relatively minor or not assessable, I tend to be more cautious and use single-agent therapy. Again, that’s because it makes sense but not because we have any data.

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