Understanding the comorbidome and its effect on survival in colorectal cancer.

210 Background: Effectively managing comorbidities is an essential component of high-quality cancer care. Evidence suggests colorectal cancer (CRC) patients with multiple comorbid conditions are less likely to complete standard treatments and can have lower rates of survival. In order to provide personalized care, it is critical to understand how comorbid conditions cluster within CRC patients. Methods: We identified Kaiser Permanente Southern California CRC patients diagnosed with first malignancy between 01/01/2008 - 12/31/2013. We used latent class analysis to identify clinically useful phenotypes defined by combinations of comorbidities at diagnosis, and compared survival using the Kaplan-Meier method. Results: The cohort included 7803 patients: 52% male; average age at diagnosis 66 years (SD: 13); 22% Hispanic, 15% Black, 9% Asian, 52% White; 42% Stage I, 22% Stage II, 22% Stage III, and 14% Stage IV. One-fifth of patients had a Charlson comorbidity index score of ≥ 4. We found 4 distinct classes (Lo-Mendell-Rubin p<0.001). Class 1 was relatively healthy with few comorbidities (Table). Class 2 included individuals with cardiovascular diseases; those in Class 3 had complicated diabetes. Class 4 members had multiple chronic conditions, including diabetes with micro- and macrovascular complications. Kaplan-Meier estimates revealed a statistically significant difference in overall survival by class (log rank p<0.001). Conclusions: We identified 4 clinically distinct classes of comorbid conditions in CRC patients. These data can be used to inform personalized care for CRC patients throughout the cancer care continuum. [Table: see text]

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Retrospective review of toxicities and response of two commonly used regimens (FOLFOX6 and XELOX) in stage IV colorectal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.13568 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 13568-13568

Author(s):

M. Mullane ◽

T. Lad ◽

B. Cleveland ◽

B. Yim ◽

D. Tamkus ◽

...

Keyword(s):

Colorectal Cancer ◽

Retrospective Review ◽

Performance Status ◽

Operating Time ◽

Stage Iv ◽

P Value ◽

Central Venous ◽

Arm Pain ◽

Stage Iv Colorectal Cancer ◽

Significant Difference

13568 Background: Oxaliplatin and 5FU based regimens have become standard first line treatment for stage IV colorectal cancer. At our institution predominately the regimens FOLFOX6 (oxaliplatin/infusional 5FU via a central venous catheter) and XELOX (oxaliplatin/ capecitabine given orally) are used. We performed a retrospective review of 40 patients to see if any differences, primarily in toxicities, but also in response, emerged. Methods: . Twenty consecutive patients with Stage IV colorectal cancer who received FOLFOX6 as initial therapy and twenty consecutive patients who received initial XELOX, with the oxaliplatin given via a peripheral IV, were analyzed. The decision to administer FOLFOX6 or XELOX was not made for clinical reasons, but came about from logistical difficulties placing central venous catheters in our institution, due to cost and operating time. Comparisons were performed with a Mann Whitney test. The two groups were well matched in terms of sex, age, and performance status. Response evaluations were made based on RECIST criteria. Results: Toxicities compared in the two groups (FOLFOX6 v. XELOX) were gastrointestinal, >Gr. II (5 v. 20%); dermatologic, >Gr. III (0 v. 35%); bone marrow, > Gr. II (15 v. 20%); neurologic, >Gr. III peripheral neuropathy (10 v. 10%); and development of arm pain/discomfort (0 v. 30%). The two toxicities reaching a significant difference, with the higher incidence from XELOX, were > Grade II dermatitis (p= 0.03) and development of arm pain (p=0.05). The response rate of FOLFOX6 was 75% and that for XELOX was 55% (p value of 0.144). Conclusions: Our conclusions from this analysis are that the two regimens are comparable in terms of response, but that FOLFOX6 may be preferable in order to avoid severe dermatitis and if XELOX is the treatment choice, serious consideration should given to administer the oxaliplatin via a central catheter. No significant financial relationships to disclose.

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Long-term maintenance capecitabine and celecoxib improved clinical outcomes by targeting colorectal cancer micrometastasis

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.14513 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 14513-14513

Author(s):

M. Zhang ◽

S. Curley ◽

C. Ng ◽

B. Kurland ◽

S. Krishnan ◽

...

Keyword(s):

Colorectal Cancer ◽

Stage Iv ◽

Complete Response ◽

Kaplan Meier ◽

Stage Iv Disease ◽

Disease Site ◽

Colorectal Cancer Patients

14513 Background: Role of mainteance therapy after achieving complete response (CR) remain undefined for patients with metasatic colorectal cancer. We studied prognostic and treatment factors including maintenance capecitabine and celecoxib (XCEL) in all 19 unresectable metastatic colorectal cancer patients (pts) who had CR from the prior XCEL study. Methods: Event charts are used to summarize the timeline of the various treatments. Kaplan-Meier survival estimates and univariate log-rank tests were used to evaluate RFS and OS as time from CR. Prognostic and treatment factors included: tumor size, metastasis number (9 solitary disease), site (13 being extrahepatic), stage on diagnosis (stage II versus III/IV), disease free interval prior to stage IV disease, surgery (5 R0, 3 R1–2 resections), lactate dehydrogenase levels, first-line irinotecan chemotherapy, radiation (9 pts ≥ 45 Gy, 3 Pts < 45 Gy), and maintenance XCEL (duration 0–50.3 months). Results: Nine of 19 patients experienced recurrence (median 13 months after CR), and 4 died during the follow-up period (median 31 months after CR). The 2-year RFS for the unresected and R1–2 resected patients was 71% versus 20% for the R0 resected patients (p = 0.07). This paradoxical RFS pattern corresponded to a RFS advantage for maintenance XCEL (p = 0.002), but not any other prognostic or treatment factors. All relapses occurred in situ following discontinuation of XCEL except for the surgical cases. Patients undergoing maintenance XCEL also benefited in OS (p = 0.04). The median OS from XCEL and from onset of metastasis reached 51.9 months (95% CI, 45 months- not reached [NR]) and 73.3 months (95% CI, NR-NR months) respectively. Conclusions: Maintenance XCEL targets colorectal micrometastases and produces a paradoxical RFS and OS advantage among the high-risk unresected/R1–2 resected patients than R0 resected patients. Prospective studies are warranted to validate roles of maintenance XCEL in the treatment of colorectal micrometastases. No significant financial relationships to disclose.

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Multivariate analysis of factors affecting overall survival in minority-based population of young colorectal cancer patients: A single-institution experience.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14186 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14186-e14186

Author(s):

Shivi Jain ◽

Kireet Agrawal ◽

Shinoj Pattali ◽

Abhijai Singh ◽

Kamal Agrawal ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Multivariate Analysis ◽

Family History ◽

Cancer Patients ◽

Stage Iv ◽

Female Ratio ◽

Stage Iv Colorectal Cancer ◽

Significant Difference ◽

Colorectal Cancer Patients

e14186 Background: Overall survival in colorectal cancer is influenced by obesity, age, gender and stage at diagnosis. However, in minority based populations, effect of the above factors on overall survival has not been studied in any detail. Hence, we undertook this retrospective study to evaluate effect of above factors on overall survival in young colorectal cancer patients. Methods: 1,195 subjects with colorectal cancer treated at John H. Stroger Hospital of Cook County between 2000 and 2008 were retrospectively analyzed. 179 subjects with age 50 years and younger were identified. 146 of 179 subjects with available Body Mass Index (BMI) in kg/m2 were included in the study. Effect of BMI, age, sex, race, LDH and CEA levels, stage, site of tumor, smoking and family history on overall survival was evaluated using standard statistical multivariate analysis. Results: In our population, 22 of 146(15%) were underweight (BMI<20), 56 of 146(38.4%) were normal weight (BMI 20-24.9), 46 of 146(31.5%) were overweight (BMI 25-29.9) and 22 of 146(15%) were obese (BMI >30). Male: female ratio was 1.4:1. 75 of 146(51.7%) were African American, 23 of 146(15.9%) were Caucasians. 50 of 146(34.2%) were stage IV colorectal cancer at diagnosis. On univariate analysis, BMI<20(p=0.031, HR 2.1, 95% CI 1.15-3.82), CEA >4ng/ml (p=0.005, HR 1.93, 95% CI 1.21-3.08) and stage IV colorectal cancer (p<0.001, HR 6.1, 95% CI 2.42-15.53) were significantly associated with decreased overall survival. LDH<200 U/L was significantly associated with improved overall survival (p 0.029, HR 0.6, 95% CI 0.391-0.950). On multivariate analysis, stage IV colorectal cancer was a single significant independent predictor of overall survival (p=0.001, 95% CI 2.47-27.78). CEA>4ng/ml was marginally significant for decreased overall survival (p=0.06, 95% CI 0.978-3.015). On the contrary, no statistically significant difference was found on overall survival with age, BMI>20, gender, race, tumor location, smoking and family history. Conclusions: Advanced stage and CEA >4ng/ml are independent prognostic variables for decreased overall survival in minority based population of young colorectal cancer.

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Pancreatic ductal adenocarcinoma (PDAC), BRCA: Detailed analysis and outcomes of cohort from Memorial Sloan Kettering Cancer Center (MSK).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.708 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 708-708

Author(s):

Parisa Momtaz ◽

Catherine Anne O'Connor ◽

Joanne F. Chou ◽

Marinela Capanu ◽

Kenneth H. Yu ◽

...

Keyword(s):

Stage Iv ◽

Ductal Adenocarcinoma ◽

Cancer Center ◽

Clinicopathologic Characteristics ◽

Entire Cohort ◽

Disease Biology ◽

Kaplan Meier ◽

Significant Difference ◽

History Of ◽

Associated Malignancy

708 Background: Given encouraging responses of platinum agents and poly-ADP ribose polymerase inhibitors (PARPi) in BRCA mutated (mut) PDAC, we sought to identify patients (pts) with BRCA mut PDAC treated at MSKCC and to evaluate outcome. Methods: Institutional database at MSK with IRB approval was queried for PDAC germline (g) or somatic (s) BRCA1/2 mut. Genomic profiling, clinicopathologic characteristics and outcomes were collected. Overall survival (OS) from diagnosis was estimated using Kaplan-Meier method. Results: n = 126 with BRCA1/2 mut PDAC were identified between 1/2011-12/2018. n = 77 (61%) male and median age of 62 (range 24-85) at diagnosis. n = 78 (62%) had g BRCA mut (n = 21 BRCA1; n = 57 BRCA2). n = 54 (43%) had a family history of BRCA-related malignancies; 35pts (28%) with a personal history of other BRCA-associated malignancy. n = 66 (52%) AJCC stage IV; of these 43pts (65%) received platinum-based therapy with a partial response (PR) in 35pts (81%); median duration 7 months (m) (range 0.5-39m). n = 40 (32%) received ≥ 4 lines of therapy (range 1-6 lines). n = 44 (35%) received PARPi and 11% (n = 14) received immunotherapy. Median OS for the entire cohort 32.1 m (95% CI 23.9, 42.6). Median OS for stage I-II 49.9m (95% CI 38.5,-); stage III 43m (95% CI 33.9,-) and stage IV 19.1m (95% CI 19.1 16.1,25.8). We did not observe a statistically significant difference in OS between BRCA1 vs BRCA2 pts. Conclusions: BRCA mut PDAC constitutes a small but likely distinct biologic subgroup. Improved OS was notable relative to historical data, possibly due to the integration of platinum and PARPi therapy and possibly due to contribution from disease biology. [Table: see text]

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Improved Overall Survival of Colorectal Cancer under Multidisciplinary Team: A Meta-Analysis

BioMed Research International ◽

10.1155/2021/5541613 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Dong Peng ◽

Yu-Xi Cheng ◽

Yong Cheng

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Multidisciplinary Team ◽

Meta Analysis ◽

Postoperative Mortality ◽

Stage Iv ◽

Cochrane Library ◽

Stage Iv Colorectal Cancer ◽

Significant Difference ◽

Colorectal Cancer Patients

Purpose. The purpose of the current meta-analysis was to evaluate whether multidisciplinary team improved overall survival of colorectal cancer. Methods. PubMed, EMBASE, and Cochrane Library database were searched from inception to October 25, 2020. The hazard ratio (HR) and 95% confidence (CI) of overall survival (OS) were calculated. Results. A total of 11 studies with 30814 patients were included in this meta-analysis. After pooling the HRs, the MDT group was associated with better OS compared with the non-MDT group ( HR = 0.81 , 95% CI 0.69-0.94, p = 0.005 ). In subgroup analysis of stage IV colorectal cancer, the MDT group was associated with better OS as well ( HR = 0.73 , 95% CI 0.59-0.90, p = 0.004 ). However, in terms of postoperative mortality, no significant difference was found between MDT and non-MDT groups ( OR = 0.84 , 95% CI 0.44-1.61, p = 0.60 ). Conclusion. MDT could improve OS of colorectal cancer patients.

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The Spectrum, Tendency and Predictive Value of PIK3CA Mutation in Chinese Colorectal Cancer Patients

Frontiers in Oncology ◽

10.3389/fonc.2021.595675 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xinhui Fu ◽

Hanjie Lin ◽

Xinjuan Fan ◽

Yaxi Zhu ◽

Chao Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Regression Analysis ◽

Stage Iv ◽

Stage Iii ◽

Wild Type ◽

Cox Regression Analysis ◽

Significant Difference ◽

Exon 9 ◽

Exon 20

BackgroundPIK3CA is a high-frequency mutation gene in colorectal cancer, while its prognostic value remains unclear. This study evaluated the mutation tendency, spectrum, prognosis power and predictive power in cetuximab treatment of PIK3CA in Chinese CRC cohort.MethodsThe PIK3CA exon 9 and 20 status of 5763 CRC patients was detected with Sanger sequencing and a high-resolution melting test. Clinicopathological characteristics of 5733 patients were analyzed. Kaplan-Meier method and nomogram were used to evaluate the overall survival curve and disease recurrence, respectively.ResultsFifty-eight types of mutations in 13.4% (771/5733) of the patients were detected. From 2014 to 2018, the mutation rate of PIK3CA increased from 11.0% to 13.5%. At stage IV, exon 20 mutated patients suffered shorter overall survival time than wild-type patients (multivariate COX regression analysis, HR = 2.72, 95% CIs = 1.47-5.09; p-value = 0.012). At stage III, PIK3CA mutated patients were more likely to relapse (multivariate Logistic regression analysis, exon 9: OR = 2.54, 95% CI = 1.34-4.73, p = 0.003; exon 20: OR = 3.89, 95% CI = 1.66-9.10, p = 0.002). The concordance index of the nomogram for predicting the recurrence risk of stage III patients was 0.685. After cetuximab treatment, the median PFS of PIK3CA exon 9 wild-type patients (n = 9) and mutant patients (n = 5) did not reach a significant difference (3.6 months vs. 2.3 months, Log-rank test, p-value = 0.513).ConclusionsWe found that PIK3CA mutation was an adverse predictive marker for the overall survival of stage IV patients and recurrence of stage III patients, respectively. Further more, we suggested that PIK3CA exon 9 mutations are not negative predictors of cetuximab treatment in KRAS, NRAS, and BRAF wild-type mCRC patients.

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Outcomes among minority patients with stage IV colorectal cancer in the Harris County Health System.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18039 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18039-e18039

Author(s):

Kelsey S. Lau-Min ◽

Preeti Prakash ◽

Aaron Thrift ◽

Benjamin Leon Musher

Keyword(s):

Colorectal Cancer ◽

Health System ◽

Cancer Care ◽

Stage Iv ◽

Safety Net ◽

Financial Assistance ◽

Comprehensive Cancer Center ◽

Harris County ◽

Assistance Program ◽

Health Delivery

e18039 Background: Colorectal cancer (CRC) mortality has declined over the last three decades, but significant racial disparities in CRC survival continue to be reported, especially for stage IV disease. Hypothesizing that these disparities arise from differences in access to care rather than tumor biology, we examined treatment patterns and outcomes among minority patients evaluated and treated for stage IV CRC in an academic safety net health system. Methods: The Harris Health System is an integrated health delivery network that utilizes tax revenue to care for predominantly minority and uninsured residents of Harris County, Texas. As the largest Harris Health facility and an affiliate of the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine, Ben Taub Hospital delivers cancer care through multidisciplinary subspecialty clinics and a robust patient assistance program. We performed a retrospective analysis of minority patients diagnosed with stage IV CRC between 1/2010 and 12/2012 who were evaluated and treated at Ben Taub Hospital. Results: We identified 103 patients of whom 40% were black, 49% were Hispanic, and 12% were Asian or Middle Eastern. 65% spoke English as their preferred language; 74% were uninsured and covered by the Harris Health Plan, a financial assistance program for individuals with incomes under 300% of the federal poverty level. 85% of patients received cancer-directed therapy, of whom 99% received standard chemotherapy with a best response rate of 67% and a disease control rate of 87%. Median overall survival was 20.7 months for all patients and 23.0 months for patients who received chemotherapy. Conclusions: The Harris Health System provides the health delivery infrastructure through which minority patients with significant socioeconomic challenges obtain financial assistance and access to quality cancer care in an academic setting, thereby leading to clinical outcomes comparable to those of the predominantly Caucasian and insured populations studied in randomized control trials. Efforts to resolve disparities in CRC outcomes should focus on improving access of at-risk populations to comprehensive cancer care.

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Selecting patients with stage II/III colorectal cancer for 5-fluorouracil-based adjuvant chemotherapy using proteomic analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.708 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 708-708

Author(s):

Dongyao Yan ◽

Ji Hyung Hong ◽

Hee Yeon Lee ◽

Jae Ho Byun ◽

Fabiola Cecchi ◽

...

Keyword(s):

Colorectal Cancer ◽

Mass Spectrometry ◽

Cohort Analysis ◽

Tumor Stage ◽

Stage Ii ◽

Disease Stage ◽

Rank Test ◽

Kaplan Meier ◽

Significant Difference ◽

Student’S T

708 Background: 5-fluorouracil (5-FU) is a common adjuvant treatment for stage III and high-risk stage II colorectal cancer (CRC). However, about 20% of patients relapse within 48 months of treatment with 5-FU, even when combined with oxaliplatin. To improve patient selection, tumor biomarkers that predict sensitivity to 5-FU have been proposed. These include proteins involved in 5-FU activation or metabolism such as uridine-cytidine kinase 2 (UCK2) and thymidylate synthase (TYMS). We used multiplexed mass spectrometry to evaluate the utility these biomarkers in the archived tumor samples of patients with stage II/III CRC. Methods: Tumor samples were from 143 patients with stage II/III CRC who received adjuvant 5-FU, folinic acid, and oxaliplatin during 2000-2014; 83% of patients received 12 cycles and the others received ≤ 11 cycles. Tumor cells were microdissected and solubilized, and 67 candidate biomarkers were quantitated using mass spectrometry. Overall survival (OS) and relapse-free survival (RFS) were assessed using the Kaplan-Meier method and log-rank test. Protein expression by tumor stage, lymph node (LN) status, tumor sidedness was compared using the Student’s t-test. Results: Of 143 patients, 45 had recurrence and 98 patients did not. UCK2 was detected in all samples, ranging from 187 to 1606 attomoles per microgram of total protein (amol/µg). Patients with UCK2 expression above 335 amol/μg (n = 109) had significantly longer OS than patients with lower expression (n = 34; HR: 0.42; p= 0.009). There was no significant difference in RFS (HR: 0.6; p= 0.088). UCK2 expression did not differ by disease stage, LN metastasis status, or tumor sidedness. TYMS expression was not associated with survival in this cohort. Analysis of other biomarkers associated with response to 5-FU and platinum is in progress. Conclusions: In stage II/III CRC, UCK2 expression above 335 amol/μg identifies a subgroup of 5-FU-treated CRC patients with longer survival, suggesting that quantitated UCK2 has potential for use in selecting patients for treatment. These findings warrant validation in larger cohorts.

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Racial disparities in immune-related adverse events (irAE) of immune checkpoint inhibitors (ICPi) and association with survival based on clinical and biochemical responses.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7025 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7025-7025

Author(s):

Monica Peravali ◽

Cristiane Gomes-Lima ◽

Eshetu Tefera ◽

Mairead Baker ◽

Mamta Sherchan ◽

...

Keyword(s):

Large Scale ◽

Checkpoint Inhibitors ◽

Stage Iv ◽

Positive Association ◽

Progression Free Survival ◽

P Value ◽

Eligibility Criteria ◽

Kaplan Meier ◽

Comparison Results ◽

Significant Difference

7025 Background: ICPi cause various irAE with thyroid dysfunction as a commonly reported abnormality. There is increasing evidence showing positive association with development of irAE and survival. However, prior trials with ICPi had underrepresentation of minorities with <5% African Americans (AA). Methods: We retrospectively reviewed patients (pts) with stage IV solid malignancies treated with PD1/PDL1 blockers between 1/2013-12/2018 across MedStar Georgetown Cancer Institute facilities. Pts treated with CTLA-4 inhibitors were excluded. Progression free survival (PFS) and overall survival (OS) were primary endpoints and were calculated using Kaplan-Meier methods and Wilcoxon rank sum test for comparison. Results: 293 pts met eligibility criteria. 91 pts (31%) had any grade irAE; most common AE were endocrine (40.7%) specifically TSH elevation, dermatological (23.1%) and rheumatologic (18.7%). Proportion of irAE was significantly higher in Caucasians versus AA (60.4% vs 30.8%), in pts with low PDL1, lower LDH, older age, and those who had more treatment cycles with ICPi. Rate of progression was lower in pts with irAE (30.8% vs 46.0%, p-0.0140). Median PFS (5.8 vs 3.0 months (mo), p- 0.0204) and OS (17.1 vs 7.2 mo, p value- <0.0001) were higher with irAE. Statistically significant difference in OS (17.1 vs 8.6 mo, p- 0.0002) but not in PFS (5.8 vs 3.3 mo, p: 0.0545) was noted with endocrine irAE. No differences in survival were observed among other commonly reported irAE. Differences in survival among subgroups of pts with irAE are detailed in table. Conclusions: Development of irAE positively correlated with improved PFS and OS as reported in previous studies. To our knowledge, this is the first study observing differences in OS favoring endocrine AE and Caucasian race. These factors may be potential surrogate markers of prognosis pending replication of these results in large-scale studies. [Table: see text]

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Comparing Survival After Recurrent vs De Novo Stage IV Advanced Breast, Lung, and Colorectal Cancer

JNCI Cancer Spectrum ◽

10.1093/jncics/pky024 ◽

2018 ◽

Vol 2 (2) ◽

Cited By ~ 2

Author(s):

Michael J Hassett ◽

Hajime Uno ◽

Angel M Cronin ◽

Nikki M Carroll ◽

Mark C Hornbrook ◽

...

Keyword(s):

Colorectal Cancer ◽

De Novo ◽

Clinical Trial Design ◽

Stage Iv ◽

Population Based ◽

Advanced Breast ◽

Research Network ◽

Matched Pairs ◽

Advanced Cancer Patients ◽

Significant Difference

Abstract The treatments provided to and survival of patients with recurrent vs de novo stage IV advanced breast, lung, and colorectal cancer may differ but have not been well studied. Using population-based data from the Cancer Research Network for 4510 patients with advanced breast, lung, or colorectal cancer, we matched recurrent/de novo patients on demographic factors. We found longer survival for recurrent vs de novo lung cancer (182 matched pairs); no significant difference for colorectal cancer (332 matched pairs); and shorter survival for recurrent vs de novo breast cancer (219 matched pairs). Compared with recurrent cases, chemotherapy use and radiation therapy use were more common among de novo cases. Differences in treatment and survival between recurrent and de novo advanced cancer patients could inform prognostic estimates and clinical trial design.

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