Perioperative therapy in patients with metastatic colorectal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18231-e18231
Author(s):  
Olatunji B. Alese ◽  
Katerina Mary Zakka ◽  
Xingyue Huo ◽  
Renjian Jiang ◽  
Walid Labib Shaib ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Multivariate Analyses ◽  
Stage Iv ◽  
Tumor Location ◽  
Primary Site ◽  
Perioperative Therapy ◽  
Younger Age ◽  
Male Preponderance ◽  
Metastatic Sites

e18231 Background: Knowledge about perioperative systemic therapy in metastatic colorectal cancer (mCRC) is limited. We aim to describe the nationwide pattern of use and survival outcomes of patients with mCRC treated with surgical resection. Methods: Data were obtained from all US hospitals that contributed to the National Cancer Database (NCDB) between 2004 and 2013. Univariate and multivariate analyses was done to identify factors associated with patient outcome. Results: A total of 61,940 patients with stage IV CRC older than 18 years were identified. Mean age was 63.4 years (SD±14), with a male preponderance (54.8%). About 80% were Caucasian and 69.9% had colon cancer. Compared to medical treatment only, resection of both primary and metastatic sites (13.5%; HR 0.40; 0.37-0.44; p < 0.001), or primary site resection alone (49.2%; HR 0.52; 0.48-0.56; p < 0.001) were associated with improved overall survival (OS). Other co-variates associated with improved survival included younger age group, year of diagnosis (2009-2013), colon tumor location, and < 3 metastatic sites (Table). Five-year OS for resection of primary and metastatic site (28.2%) was higher than for primary site resection alone (14.9%) or no surgical treatment (4.7%). Conclusions: Resection of metastatic sites or primary tumor was associated with improved survival in patients with stage IV CRC.[Table: see text]

Assessing real-world outcomes in metastatic colorectal cancer with KRASG12C mutation.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16072-e16072
Author(s):  
Hui-Li Wong ◽  
Wanyuan Cui ◽  
Matthew Loft ◽  
Margaret Lee ◽  
Rachel Wong ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Clinical Features ◽  
Real World ◽  
Predictive Biomarker ◽  
Tumor Location ◽  
Prognostic Impact ◽  
Braf Mutations ◽  
Specific Targeting ◽  
Metastatic Sites

e16072 Background: The KRASG12C mutation is present in 3% of colorectal cancer and is of particular interest given the recent development of specific targeting drugs. Previous data suggest KRAS (all) mutations may impact prognosis. Here we assess the clinical features and outcomes of real world patients with KRASG12C mutant metastatic colorectal cancer (mCRC) to explore any clinicopathologic associations and prognostic impact. Methods: Patients diagnosed with mCRC between January 2011 and December 2018 were included in this prospective mCRC registry. Patients with BRAF mutations, unknown or unspecified KRAS variants were excluded. Clinicopathologic features, treatment and overall survival (OS) were compared for RAS wildtype (RASWT) and KRASG12C mutant patients, and between KRASG12C and other (RASother) mutations. Results: Of 1308 patients analysed, 674 (52%) were RASmut, of whom 56 (8.3%) were KRASG12C. More patients with KRASG12C were female compared to RASother and RASWT (Table). No differences were observed in primary tumor location, number of metastatic sites and distribution of metastases. The proportion of patients undergoing metastasectomy was similar between KRASG12C and RASother, and KRASG12C and RASWT. There was no difference in the proportion of patients receiving systemic therapy. RASWT patients received more lines of therapy. Median OS was similar between KRASG12C, RASother, and RASWT: 31.7 vs 29.2 vs 31.8 months respectively (P = 0.545). Conclusions: KRASG12C mutations were observed in 4.3% of mCRC patients and in 8.3% of RAS mutant cases. Patients with KRASG12C have comparable clinical features to RASWT or RASother mCRC. Treatment and survival were also similar between groups. KRASG12C does not appear to be prognostic, but may be an important predictive biomarker as promising targeted therapies continue to be developed. [Table: see text]

Clinical and molecular characterization of patients with metastatic colorectal cancer harbouring DNA mismatch repair deficiency.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3563-3563
Author(s):  
Romain Cohen ◽  
Elisabeth Hain ◽  
Pascale Cervera ◽  
Olivier Buhard ◽  
Sylvie Dumont ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Mismatch Repair ◽  
Metastatic Disease ◽  
Demographic Data ◽  
Stage Iv ◽  
Proximal Colon ◽  
Mismatch Repair Deficiency ◽  
Repair Deficiency ◽  
Metastatic Sites

3563 Background: Prognosis of patients (pts) with metastatic colorectal cancer (mCRC) harboring microsatellite instability (MSI) is poorly characterized. We aimed to assess the clinical relevance of distinguishing sporadic (SP) from Lynch syndrome (LS)-related mismatch repair deficiency (dMMR). Methods: Pts with diagnostic of dMMR and/or MSI mCRC between 1998 and 2016 were retrospectively identified in 6 French hospitals. Tumor samples were systematically collected and screened for RAS/RAF mutations and MLH1 promotor methylation. dMMR and MSI statuses were confirmed using immunohistochemistry and Pentaplex© PCR assay. Sporadic cases were molecularly defined as those displaying MLH1 loss of expression with BRAFV600E mutation and/or MLH1 hypermethylation. Clinical data (demographic data, metastatic sites, therapeutic strategies) were recorded. Results: 129 pts, of which 48 SP and 81 LS, were included. Compared with LS, SP were associated with female (P < .001), older age at diagnostic (P < .001), proximal colon (P = 0.002), and less liver metastasis (25% vs 47%, P = .02). For initially localized CRC, median disease free survivals (DFS) were 9.1 months (m) for SP (n = 22) and 12.3 m for LS (n = 47) (hazard ratio (HR) = 0.5, 95%CI 0.28-0.90, P = .02). Median overall survivals (OS) from stage IV diagnosis were 43.9 m in the overall population, 23 m for SP and not reached for LS (HR = 0.23, 95%CI 0.10-0.52, P < .001). BRAF mutation was harbored by 29 SP tumors (60%) and did not impact OS among SP pts (P = .52). Metastatic disease was less frequently resectable for SP than LS (21% vs 56%, P < .001). Median DFS for pts with resected metastatic disease (n = 55) were respectively 6.7 and 10.5 m (HR = 0.28, 95%CI 0.10-0.73, P = .01). At the data cut-off date, 16 pts (15 LS and 1 SP) were still in complete remission. Median progression free survivals with first-line chemotherapy for pts with unresectable metastasis (n = 61) were 3.9 m for SP and 5.0 m for LS (P = .71). Conclusions: This retrospective study suggests a worse prognosis of pts with SP MSI mCRC compared to these with LS-related mCRC.

scholarly journals The Impact of Primary Tumor Location in Synchronous Metastatic Colorectal Cancer: Differences in Metastatic Sites and Survival

2019 ◽  
Vol 27 (5) ◽  
pp. 1580-1588 ◽  
Author(s):  
Nelleke P. M. Brouwer ◽  
Dave E. W. van der Kruijssen ◽  
Niek Hugen ◽  
Ignace H. J. T. de Hingh ◽  
Iris D. Nagtegaal ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Cancer Patients ◽  
Primary Tumor ◽  
Relative Survival ◽  
Tumor Location ◽  
Primary Tumor Location ◽  
Metastatic Sites ◽  
The Impact

Abstract Purpose We explored differences in survival between primary tumor locations, hereby focusing on the role of metastatic sites in synchronous metastatic colorectal cancer (mCRC). Methods Data for patients diagnosed with synchronous mCRC between 1989 and 2014 were retrieved from the Netherlands Cancer registry. Relative survival and relative excess risks (RER) were analyzed by primary tumor location (right colon (RCC), left colon (LCC), and rectum). Metastatic sites were reported per primary tumor location. Survival was analyzed for metastatic sites combined and for single metastatic sites. Results In total, 36,297 patients were included in this study. Metastatic sites differed significantly between primary tumor locations, with liver-only metastases in 43%, 54%, and 52% of RCC, LCC, and rectal cancer patients respectively (p < 0.001). Peritoneal metastases were most prevalent in RCC patients (33%), and lung metastases were most prevalent in rectal cancer patients (28%). Regardless of the location of metastases, patients with RCC had a worse survival compared with LCC (RER 0.81, 95% CI 0.78–0.83) and rectal cancer (RER 0.73, 95% CI 0.71–0.76). The survival disadvantage for RCC remained present, even in cases with metastasectomy for liver-only disease (LCC: RER 0.66, 95% CI 0.57–0.76; rectal cancer: RER 0.84, 95% CI 0.66–1.06). Conclusions This study showed significant differences in relative survival between primary tumor locations in synchronous mCRC, which can only be partially explained by distinct metastatic sites. Our findings support the concept that RCC, LCC and rectal cancer should be considered distinct entities in synchronous mCRC.

Impact of Site-Specific Metastases on Surgical Value and Survival among Metastatic Colorectal Cancer Patients

2020 ◽  
Vol 86 (3) ◽  
pp. 220-227
Author(s):  
Zhen Zong ◽  
Tai-Cheng Zhou ◽  
Fu-Xin Tang ◽  
Hua-Kai Tian ◽  
Anan Wang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Cancer Patients ◽  
Surgical Resection ◽  
Pulmonary Metastases ◽  
Stage Iv ◽  
Prognostic Impact ◽  
Stage Iv Colorectal Cancer ◽  
Metastatic Sites ◽  
Colorectal Cancer Patients

We aimed to explore the potential prognostic impact of the metastatic site on the management approach and prognosis of stage IV colorectal cancer patients with synchronous metastases. Synchronous metastatic colorectal cancer patients reported to the Surveillance, Epidemiology, and End Results Program database between 2010 and 2013 were included in this study. Overall survival (OS) was compared between patients with different treatment options using risk-adjusted Cox proportional hazard regression models. Overall, 17,776 patients with stage IV colorectal cancer were identified. Of these patients, 2,052 (11.5%) underwent surgical resection for tumors at both the primary and meta-static sites. Patients who underwent surgical resection of both primary and metastatic sites with liver, lung, and simultaneous liver and lung metastases had a longer median OS ( P < 0.001) than patients who underwent nonsurgical treatments. Cox regression analysis revealed that surgical resection of both primary and metastatic sites was associated with a significantly enhanced OS ( P < 0.001). Colorectal cancer patients with hepatic or pulmonary metastases, who underwent metastasectomy, even in selected patients with both hepatic and pulmonary metastases after multidisciplinary evaluation, could have a better survival benefit than patients who underwent nonsurgical treatments.

scholarly journals Impact of biomarkers and primary tumor location on the metastatic colorectal cancer first-line treatment landscape in five European countries

2021 ◽  
Author(s):  
George Kafatos ◽  
Victoria Banks ◽  
Peter Burdon ◽  
David Neasham ◽  
Kimberly A Lowe ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Primary Tumor ◽  
Treatment Strategies ◽  
Treatment Decisions ◽  
Tumor Location ◽  
First Line ◽  
Primary Tumor Location ◽  
The Uk ◽  
Prognostic And Predictive Factors

Background: Advances in therapies for patients with metastatic colorectal cancer (mCRC) and improved understanding of prognostic and predictive factors have impacted treatment decisions. Materials & methods: This study used a large oncology database to investigate patterns of monoclonal antibody (mAb) plus chemotherapy treatment in France, Germany, Italy, Spain and the UK in mCRC patients treated in first line in 2018. Results: Anti-EGFR mAbs were most often administered to patients with RAS wild-type mCRC and those with left-sided tumors, while anti-VEGF mAbs were preferred in RAS mutant and right-sided tumors. Adopted treatment strategies differed between countries, largely due to reimbursement. Conclusion: Biomarker status and primary tumor location steered treatment decisions in first line. Adopted treatment strategies differed between participating countries.

scholarly journals A Postauthorization Survey to Document the Therapeutic Management of Oxaliplatin as a First-Line Chemotherapy Regimen in South Africa in Patients with Metastatic Colorectal Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-8
Author(s):  
Lydia M. Dreosti ◽  
Alicia McMaster ◽  
Rashem Mothilal
Keyword(s):  
Colorectal Cancer ◽  
South Africa ◽  
Survival Rate ◽  
Metastatic Colorectal Cancer ◽  
Chemotherapy Regimen ◽  
Stage Iv ◽  
Sensory Neuropathy ◽  
Therapeutic Management ◽  
First Line ◽  
Open Label

Oxaliplatin is a standard first-line treatment for metastatic colorectal cancer. The objectives were to document the therapeutic management of oxaliplatin in South Africa, determine the incidence and severity of sensory neuropathy, and record the 2-year survival rate. Meccelox was a prospective, noncontrolled, open label, multicentre, observational survey of adult patients with stage IV metastatic colorectal cancer treated with oxaliplatin-based chemotherapeutic regimens. The study was conducted from August 2007 to November 2011 in 29 sites in South Africa by 66 participating treating physicians. Among the 195 enrolled patients, 61% were treated with FOLFOX regimen (5-fluorouracil/folinic acid plus oxaliplatin) for an average of 12 cycles and 32% patients were treated with XELOX (capecitabine plus oxaliplatin) for an average of 6–8 cycles, with the main reason for discontinuation being completion of the preplanned prescribed regimen. In Meccelox survey, 80% of patients were treated with intent of palliation. Overall 64% of patients reported symptoms of sensory neuropathy. The 2-year survival rate was 30%. Conclusions. Patients received a specified preplanned number of chemotherapy cycles rather than being treated until disease progression or toxicity. Both the incidence of neuropathy and the 2-year survival rate were less than previous reports.

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