Clinical outcome summary. (A) A flow diagram indicating progress of patients treated on the VEPEMB phase 2 study. Patient responses to chemotherapy are shown. Thirteen patients failed comorbidity assessment (designated “frail”) and were not eligible for the VEPEMB study. Comparison of the “frail” group with all VEPEMB indicates inferior treatment response (P < .001, Fisher exact test). A similar effect was evident on survival (P < .001, log-rank test). AS indicates advanced-stage disease; ES, early-stage disease; and NA, not assessable for response. (B) Choice of therapy for patients treated on the registration arm of the study. AS indicates advanced-stage disease; ES, early-stage disease; and NA, not assessable for response.