Trends in primary surgical resection and chemotherapy for metastatic colorectal cancer, 2000-2016.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16000-e16000
Author(s):  
Nina Niu Sanford ◽  
Michael Ryan Folkert ◽  
Todd Anthony Aguilera ◽  
Muhammad Shaalan Beg ◽  
Syed Mohammad Ali Kazmi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Logistic Regression ◽  
Metastatic Colorectal Cancer ◽  
Surgical Resection ◽  
Primary Tumor ◽  
Cohort Analysis ◽  
Local Treatment ◽  
Primary Tumors ◽  
Primary Surgery ◽  
Multivariable Logistic Regression

e16000 Background: When, whether and in whom resection of the primary tumor for patients with metastatic colorectal cancer (CRC) is indicated remains incompletely elucidated, although a recent randomized trial (JCOG1007, presented at GI ASCO 2020) showed no survival benefit in resection of asymptomatic primary tumors in this population. Given the emergence of multiagent chemotherapy, surgery may be used less, but patterns of care for metastatic CRC have not been reported. As such, we sought to evaluate trends in use of primary surgical resection and chemotherapy among patients with metastatic CRC. Methods: Patients diagnosed with metastatic CRC between 2000-2016 were identified from the Surveillance, Epidemiology and End Results (SEER) registry. Multivariable logistic regression defined odds of undergoing primary surgical resection, with year of diagnosis as the primary independent variable. The cohort analysis was also stratified by primary site (colon versus rectum), age ( < 50 vs. >50 years) and whether patients also underwent resection of metastatic sites (yes versus no). The secondary endpoint of interest was receipt of any chemotherapy, also assessed by multivariable logistic regression. Results: Among 99,835 patients with metastatic CRC, 55,527 (55.7%) underwent resection of their primary tumor. The odds of undergoing primary surgery decreased with later year of diagnosis, with patients diagnosed in 2016 61.1% less likely to undergo surgery than those diagnosed in 2000 (AOR 0.39, 95% CI 0.36-0.42, p < 0.0001; absolute percent 62.3% to 43.8%). Black patients and women were also less likely to have surgery (p < 0.001). Similar trends by year for primary surgery were observed among each of the subgroups, although patients with colon primary, young adults (age < 50), and patients also undergoing metastatectomy were more likely to undergo primary surgery (p < 0.001 for all). In contrast, the odds of receiving chemotherapy increased dramatically with later year of diagnosis, with patients diagnosed in 2016 221% more likely to receive chemotherapy than those diagnosed in 2000 (AOR 2.21, 95% CI 2.04 to 2.40, p < 0.0001; 45.5% to 64.0%). Conclusions: From 2000-2016, we observed a sharp decline in the rate of primary surgical resection for patients with metastatic CRC, while use of chemotherapy increased over the same period. Prospective studies are needed to define the optimal local treatment for patients with metastatic CRC, perhaps with stratification by molecular and clinical characteristics, in order to optimize both cancer-specific and symptomatic outcomes.

Predictors of survival during treatment of metastatic colorectal cancer with an intermittent chemotherapy regimen.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14063-e14063
Author(s):  
Camilla J S Kronborg ◽  
Anni Ravnsbæk Jensen
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Metastatic Colorectal Cancer ◽  
Treatment Regimen ◽  
Primary Tumor ◽  
Local Treatment ◽  
Intermittent Treatment ◽  
Primary Tumor Site ◽  
Unselected Cohort ◽  
Improved Outcome

e14063 Background: Patients with metastatic colorectal cancer (mCRC) undergo month to year-long therapy with different chemotherapy regimens and biological agents. We aimed to identify predictors of mortality during an intermittent treatment regimen in an unselected cohort of patients with mCRC. Methods: Consecutive patients, treated from August 2007 until June 2011, were included. Standard 1st line treatment was biweekly FLIRI plus Bevacizumab. Clinical information was obtained from patient files. The outcome was overall survival. Cox regression analysis was used to identify predictors of outcome. We analyzed reduction in chemotherapy dosage (no reduction, ≤75% or >75%), administration of Bevacizumab to ≤50% of chemotherapy treatments, best response during the first 6 months of treatment (NC, RD or PD), and local treatment of metastases (any type). We adjusted for following baseline variables: Gender, age, PS, primary tumor site, resection of primary tumor, metachronous metastases, more than two metastatic sites, liver-only metastases, and low albumin Results: We included 314 patients (median age 64.5 IQ (57-70) years, 194 (61.8%) male). Median follow-up for survival was 471 IQ (257-708) days. One-year survival was 79%, CI (74-84%). Median overall survival was 676 days, CI (577-750). Chemotherapy reduction did not influence outcome, ≤75%: HR 1.08 CI (0.64-1.83), p=0.77, >75%: HR 0.66 CI (0.29-1.5), p=0.32. Local treatment of metastases was borderline significant: HR 0.45 CI (0.20-1.00), p=0.051. Bevacizumab was administered in 262 patients and a reduction in bevacizumab treatments was associated with increased mortality: HR 1.90 CI (1.12-3.23), p=0.018. Regression vs. NC improved outcome HR 0.48 (0.30-0.78), p=0.003, whereas PD vs. NC increased mortality HR 3.84 (1.75-8.42), p=0.001. Conclusions: In an unselected cohort of mCRC patients, using an intermittent treatment regimen, administration of Bevacizumab to less than 50% of chemotherapy treatments and PD were associated with increased mortality. Regression improved outcome compared to stable disease. Local treatment of metastases was borderline significant. Reduction in chemotherapy dosage did not influence outcome.

Impact of primary tumor sidedness on erlotinib efficacy in patients with metastatic colorectal cancer treated with bevacizumab maintenance: Results from the DREAM phase III trial.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 737-737 ◽  
Author(s):  
Benoist Chibaudel ◽  
Thierry Andre ◽  
Benoit Samson ◽  
Marie-Line Garcia-Larnicol ◽  
Jérôme Dauba ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Monoclonal Antibodies ◽  
Maintenance Therapy ◽  
Metastatic Colorectal Cancer ◽  
Clinical Outcomes ◽  
Primary Tumor ◽  
Phase Iii ◽  
Primary Tumors ◽  
Phase Iii Trial ◽  
Mutational Status

737 Background: Primary tumor sidedness (PTS) could be a predictive maker for treatment efficacy of EGFR inhibitors monoclonal antibodies in patients with wild-type (WT) RAS metastatic colorectal cancer (MCRC), cetuximab having limited efficacy in patients with WT-RAS right-sided tumors. DREAM study demonstrated that adding erlotinib, an oral EGFR tyrosine kinase inhibitor (TKI) to bevacizumab during maintenance therapy improved clinical outcomes (RR, PFS, OS) in patients with MCRC, whatever KRAS status. The aim of this post-hoc analysis is to evaluate the clinical outcomes according to KRAS mutational status and PTS when adding erlotinib to bevacizumab maintenance therapy. Methods: PTS was retrospectively collected in patients from the DREAM phase III trial treated with bevacizumab with or without erlotinib as maintenance therapy for MCRC who have been controlled by induction therapy. The limit for the definition of PTS was splenic flexure, and rectal tumors were considered as left-sided tumors. The primary endpoint was overall survival (OS). Results: Among 452 patients who received maintenance therapy, PTS ascertainment was 84.7% (n = 383) with 265 (71.0%) patients having left-sided primary tumor and 108 (28.9%) having right-sided primary tumors (3 patients had both and tumor location was unknown in 7 patients). Median OS and treatment effect are presented in table 1. Conclusions: The greatest OS benefit of adding erlotinib to bevacizumab maintenance therapy was observed in patients with WT-KRAS and right-sided MCRC, suggesting a clinical impact of the different mechanism of action between EGFR TKI and monoclonal antibodies. Clinical trial information: NCT00265824. [Table: see text]

scholarly journals Mitochondrial DNA alteration in primary and metastatic colorectal cancer: Different frequency and association with selected clinicopathological and molecular markers

Tumor Biology ◽  
2017 ◽  
Vol 39 (3) ◽  
pp. 101042831769224 ◽  
Author(s):  
Britta Kleist ◽  
Thuja Meurer ◽  
Micaela Poetsch
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Microsatellite Instability ◽  
Metastatic Colorectal Cancer ◽  
Lymph Node Metastases ◽  
Primary Tumor ◽  
Distant Metastases ◽  
Primary Tumors ◽  
Node Metastases ◽  
Mitochondrial Microsatellite Instability

This study attempts to determine whether primary tumor tissue could reliably represent metastatic colorectal cancer in therapy-guiding analysis of mitochondrial microsatellite instability. Therefore, we investigated the concordance of microsatellite instability in D310, D514, and D16184 (mitochondrial DNA displacement loop), and its association with selected clinical categories and KRAS/NRAS/BRAF/PIK3CA/TP53 mutation status between primary and metastatic colorectal cancer tissue from 119 patients. Displacement loop microsatellite instability was significantly more frequently seen in lymph node metastases (53.1%) compared to primary tumors (37.5%) and distant metastases (21.4%) ( p = 0.0183 and p = 0.0005). The discordant rate was significantly higher in lymph node metastases/primary tumor pairs (74.6%) than in distant metastases/primary tumor pairs (52.4%) or lymph node metastases/distant metastases pairs (51.6%) ( p = 0.0113 and p = 0.0261) with more gain (86.7%) than loss (61.1%) of microsatellite instability in the discordant lymph node metastases ( p = 0.0024). Displacement loop instability occurred significantly more frequently in lymph node metastases and distant metastases of patients with early colorectal cancer onset age <60 years ( p = 0.0122 and p = 0.0129), was found with a significant high rate in a small cohort of TP53-mutated distant metastases ( p = 0.0418), and was associated with TP53 wild-type status of primary tumors ( p = 0.0009), but did not correlate with KRAS, NRAS, BRAF, or PIK3CA mutations. In conclusion, mitochondrial microsatellite instability and its association with selected clinical and molecular markers are discordant in primary and metastatic colorectal cancer, which could have importance for surveillance and therapeutic strategies.

Primary tumor resection to improve survival in patients with metastatic colorectal cancer in the post-2000 era: A California Cancer Registry analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14570-e14570
Author(s):  
Ana Milena Rodriguez Fahrni ◽  
I-Yeh Gong ◽  
Rosemary Cress ◽  
Yingjia Chen ◽  
Thomas John Semrad ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Metastatic Colorectal Cancer ◽  
Cancer Registry ◽  
Systemic Therapy ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Primary Tumor Resection ◽  
Primary Tumors ◽  
California Cancer Registry

e14570 Background: Resection of primary tumors in the setting of metastatic colorectal cancer (MCRC) is controversial. Fewer primary tumor resections are being performed due to the improved tumor responses and disease control rates associated with modern systemic therapy. Recent studies suggest a survival benefit for patients with MCRC who had primary tumors resection prior to systemic therapy. This analysis evaluates the independent prognostic impact of primary tumor resection on overall survival (OS) for patients with MCRC using the California Cancer Registry (CCR). Methods: We queried the CCR for all patients with MCRC diagnosed between 2003 and 2010. Patients were categorized by whether or not they had primary tumor resection at time of diagnosis. Covariates included gender, age, race/ethnicity, socioeconomic status (SES), and rural-urban commuting area (RUCA) score of patients. Univariate comparisons were made using the Kaplan Meier method. Multivariate comparisons were performed using the Cox proportional hazards regression method. Results: 19,836 patients met the criteria for analysis of whom 11,566 (58%) had primary tumor resection. Primary tumor resection rates declined over this time period (63% in 2003 v. 52.8% in 2010, p<0.0001), varied by SES (55% v. 62%: lowest versus highest, p<0.001) and residence (63% in rural versus 58% for urban, P=0.0160). On multivariate analysis, overall survival was significantly better for patients that had primary tumor resection (HR: 0.467 [95% CI: 0.467-0.482]; p<0.0001). Survival was statistically longer in younger patients (HR: 1.385 for age 65-75, HR: 2.217 if greater than age 75), highest SES (HR: 0.869, p<0.0001), Hispanics (HR: 0.884, p<0001), and Asian/Pacific Islanders (HR:0.892, p<0.0001). Overall survival was worse for African Africans (HR:1.105, P=0.0001). Conclusions: Our study demonstrates the independent prognostic value on survival of primary tumor resection in patients with MCRC. There is significant variability of resection rates by SES and rural-urban residence. As analysis of CCR data cannot eliminate the influence of patient and provider biases, a prospective randomized trial is warranted.

EGFR and KRAS mutations during anti-EGFR monoclonal antibody treatment in metastatic colorectal cancer: Clinically relevant?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3513-3513
Author(s):  
Lucie Karayan-Tapon ◽  
Aurelie Ferru ◽  
Ulrich Cortes ◽  
Claire Villalva ◽  
Jean Marc Tourani ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Monoclonal Antibody ◽  
Disease Control ◽  
Metastatic Colorectal Cancer ◽  
Primary Tumor ◽  
Kras Mutation ◽  
Wild Type ◽  
Antibody Treatment ◽  
Kras Mutations ◽  
Primary Tumors

3513 Background: It is well-established that only patients with wild-type KRAS metastatic colorectal cancer (mCRC) benefit from treatment with an epidermal growth factor receptor monoclonal antibody (anti-EGFR mAb). Recently, in patients with tumor progression after anti-EGFR mAb, occurrence of EGFR mutation (n=2/10) [Montagut C et al., Nat Med 2012] or KRAS mutation (n=6/10) [Misale S et al., Nature 2012] in metastases has been identified. These mutations could explain treatment resistance but still need to be confirmed with simultaneous analysis of KRAS and EGFR mutations. Methods: We analyzed 37 tumor samples after anti-EGFR mAb treatment for mCRC (34 from metastasis lesions and 3 from primary tumors). We analyzed KRAS (codons 12 and 13), BRAFV600E and EGFRS492R mutations using a highly sensitive technique, pyrosequencing (TheraScreen KRAS Pyro Kit, Qiagen). All tumors were KRAS, BRAFV600E and EGFRS492Rwild-type before anti-EGFR mAb treatment. Results: The majority of patients were treated using anti-EGFR mAb in first-line chemotherapy (70%) and combined with cytotoxic chemotherapy (96%). Cetuximab was used in 86% and panitumumab in 14% of the cases. Among the 37 tumor specimens, 8 were collected after disease progression, and the others after disease control. No EGFRS492R mutation was detected. No tumors developed BRAF mutation but one tumor acquired a KRAS mutation. Nevertheless, the KRAS mutation in this patient (G12V) was detected, after 5-fluorouracil plus cetuximab therapy, only in the primary tumor in the colon but not in the liver metastasis. Moreover, there was a disease control (partial response). Conclusions: Our results suggest that EGFRS492R and acquired KRAS mutations during anti-EGFR mAb therapy are not the only factors accounting for anti-EGFR resistance. Moreover, occurrence of KRAS mutation during anti-EGFR therapy could differ between primary tumor and metastases.

Effect of primary tumor resection on survival in patients with metastatic colorectal cancer in the post-2000 era: A California Cancer Registry analysis.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 504-504
Author(s):  
Ana Milena Rodriguez Fahrni ◽  
I-Yeh Gong ◽  
Yingjia Chen ◽  
Rosemary Cress ◽  
Thomas John Semrad ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Metastatic Colorectal Cancer ◽  
Cancer Registry ◽  
Systemic Therapy ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Primary Tumor Resection ◽  
Primary Tumors ◽  
California Cancer Registry

504 Background: Resection of primary tumors in the setting of metastatic colorectal cancer (MCRC) is controversial. Fewer primary tumor resections are being performed due to the improved tumor response and disease control rates associated with modern systemic therapy. Recent studies suggest a survival benefit for patients with MCRC who had primary tumors resection prior to systemic therapy. This analysis evaluates the independent prognostic impact of primary tumor resection on overall survival (OS) for patients with MCRC using the California Cancer Registry (CCR). Methods: We queried the CCR for all patients with MCRC diagnosed between 2003 and 2010. Patients were categorized by whether or not they had primary tumor resection at time of diagnosis. Covariates included gender, age, race/ethnicity, socioeconomic status (SES), and rural-urban commuting area (RUCA) score of patients. Univariate comparisons were made using the Kaplan Meier method. Multivariate comparisons were performed using the Cox proportional hazards regression method. Results: 19,836 patients met the criteria for analysis of whom 11,566 (58%) had primary tumor resection. Primary tumor resection rates declined over this time period (63% in 2003 v. 52.8% in 2010, p<0.0001), varied by SES (55% v. 62%: lowest versus highest, p<0.001) and residence (63% in rural versus 58% for urban, P=0.0160). On multivariate analysis, overall survival was significantly better for patients that had primary tumor resection (HR: 0.467 [95% CI: 0.467-0.482]; p<0.0001). Survival was statistically longer in younger patients (HR: 1.385 for age 65-75, HR: 2.217 if greater than age 75), highest SES (HR: 0.869, p<0.0001), Hispanics (HR: 0.884, p<0001), and Asian/Pacific Islanders (HR:0.892, p<0.0001). Overall survival was worse for African Americans (HR:1.105, P=0.0001). Conclusions: Our study demonstrates the independent prognostic value on survival of primary tumor resection in patients with MCRC. There is significant variability of resection rates by SES and rural-urban residence. As analysis of CCR data cannot eliminate the influence of patient and provider biases, a prospective randomized trial is warranted.

Mutational landscape of metastatic colorectal cancer: Aggregate insights from a molecular tumor board.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 837-837
Author(s):  
Mark Andrew Lewis ◽  
Derrick S. Haslem ◽  
Ramya Thota ◽  
Terence Duane Rhodes ◽  
Tyler Barker ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Next Generation Sequencing ◽  
Metastatic Colorectal Cancer ◽  
Primary Tumor ◽  
Stage Iv ◽  
Tumor Board ◽  
Primary Tumors ◽  
Multiple Metastases ◽  
Molecular Tumor Board ◽  
Generation Sequencing

837 Background: The mutational landscape of metastatic colorectal cancer (CRC) is being elucidated by next-generation sequencing of both primary tumors and metastatic foci. In this study, we examined the results of all stage IV CRC cases submitted to our molecular tumor board (MTB). Methods: We performed a retrospective analysis of all patients who had next-generation sequencing performed between January 2015 and August 2017 on either their primary tumor and/or metastasis. Cases were presented at a MTB convened twice monthly. For the purposes of this study only pathogenic mutations were notated, not variants of unknown significance (VUS). Results: Eighty-seven unique patients had 97 specimens sequenced (28 primary tumors and 69 metastases). The primaries averaged 3 mutations per specimen (range: 1-6) whereas the metastases averaged 4 (range: 1-14, p=.25). The most common anatomic sites of submitted metastatic tissue were the liver (n=35, average mutations=4), followed by the lungs (n=10, average mutations=3) and the omentum/peritoneum (n=8, average mutations=3). Two patients had both a primary tumor and a metastasis sequenced, with a 33% rate of concordance in inter-specimen mutations. Five patients had multiple metastases sequenced, with a 53% rate of concordance in inter-specimen mutations; in every case of longitudinal sequencing, mutational burden increased in metastases over time. The most common mutation was apc (21% of all mutations), followed by p53 (16%) and then kras (13%). Candidacy for EGFR-directed therapy was found in 8 cases, and mismatch repair defects were detected in 5 cases. Conclusions: In stage IV CRC cases sent to our MTB, tissue from metastases was more commonly submitted for analysis than from the primary tumors. There is not necessarily concordance between mutations in primary tumors and metastases, nor among multiple metastases in the same patient. Sequencing at multiple time points in the disease course may allow observation of clonal evolution and dynamic adaptation of therapeutic targets.

scholarly journals Clinical Outcomes of Metastatic Colorectal Cancer Following Surgical Resection of the Primary tumor at Hiwa Cancer Hospital, Sulaimani, Iraq

2021 ◽  
Vol 10 (1) ◽  
pp. 7-12
Author(s):  
Kadhim Faruq Namiq ◽  
Kosar Mohammad Ali ◽  
Mohammed Ibrahim Mohialdeen Gubari
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Clinical Outcomes ◽  
Surgical Resection ◽  
Primary Tumor ◽  
Smoking Habit ◽  
Primary Tumors ◽  
Female Ratio ◽  
Cancer Hospital ◽  
One Year

Background: Colorectal cancer (CRC) is one of the main causes of cancer-related mortality. The surgical resection of primary CRC tumors is a critical line of treatment. The present study investigated the clinical outcomes of the surgical resection of the primary tumor in metastatic CRC patients. Materials and Methods: In this prospective and retrospective study, 81 metastatic CRC patients were recruited at Hiwa Cancer Hospital in Sulaimani, Iraq from January 2016 to December 2019. Forty-one patients underwent surgical resection of their primary tumor while the remaining 40 patients did not undergo resection. Data regarding patients’ clinical outcomes were obtained from the clinical portal system of the hospital and were analyzed using SPSS (version 23.0). Results: The patients’ mean (± SD) age was 53.5 (± 17.02) years and the male-to-female ratio was 1.3:1. Patients undergoing the surgical resection of their primary tumors had a significantly better one-year survival compared to those who did not undergo resection (P = 0.04). Based on the results, patients in the surgical resection group continued to have a better overall survival although it was not statistically significant (P = 0.1). Significantly more patients with colon cancer underwent surgical resection compared to rectal cancer (P = 0.03), and smoking habit negatively affected the chance to undergo surgical resection (P = 0.009). Conclusion: In general, the surgical resection of the primary tumor has a significant favorable impact on one-year survival, but possibly not on overall survival. The primary site of the tumor and smoking habits significantly influence the chance to undergo surgical resection whereas the grade of the tumor or the type of systemic therapy has no significant impact in this regard.

Primary tumor location and expression of mir-664 as a combined biomarker for bevacizumab effectiveness in metastatic colorectal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3572-3572 ◽  
Author(s):  
Mogens Karsboel Boisen ◽  
Christian Dehlendorff ◽  
Dorte Linnemann ◽  
Jim S. Larsen ◽  
Kell Oesterlind ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Sigmoid Colon ◽  
Primary Tumor ◽  
Tumor Location ◽  
Cox Proportional Hazards ◽  
First Line ◽  
Significant Positive Association ◽  
Primary Tumors ◽  
Primary Tumor Location

3572 Background: We aimed to identify tissue microRNAs (miRs) that could predict outcome for patients with metastatic colorectal cancer (mCRC) treated with first line bevacizumab (BEV) and chemotherapy (CT) but not for patients treated with CT alone. Methods: Patients with mCRC treated with first line capecitabine and oxaliplatin (CT) with or without BEV at ten hospitals were identified and data was extracted retrospectively. Formalin-fixed paraffin-embedded tissue samples from primary tumors were collected and RNA was purified from 3 x 10 µm sections, without micro-dissection. miR expression was measured using Applied Biosystems TaqMan Custom LDA cards profiling 22 selected miRs in duplicate. The 22 miRs were selected from a previous discovery study profiling 754 miRs. miR expression was related to time to disease progression (TTP) and overall survival (OS) in multivariate analyses using Cox proportional hazards models with adjustment for age, prior adjuvant treatment, and no. of metastatic sites. We have previously found that patients with primary tumors originating in the sigmoid colon and rectum (S+R) experienced a better outcome than patients with other primary tumor locations (caecum to descending colon) when treated with BEV, so our analyses were stratified by primary tumor location. Results: miR expression was measured in samples from 399 patients: 155 samples from the original CT+BEV discovery study, 119 samples from a new CT+BEV cohort, and 125 samples from a CT alone cohort. Expression of miR-664 showed a significant positive association with increasing TTP, OS, and response rate (RR), but only in the cohort of patients with sigmoid colon- and rectal primary tumors treated with CT+BEV (n=183). Conclusions: We have identified a subgroup of patients with mCRC that are likely to benefit from BEV addition to first line CT using the combined information of location of the primary tumor and expression level of miR-664. [Table: see text]

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