scholarly journals A retrospective observational study to estimate the attrition of patients across lines of systemic treatment for metastatic colorectal cancer in Canada

2019 ◽  
Vol 26 (6) ◽  
Author(s):  
H. Kennecke ◽  
S. Berry ◽  
J. Maroun ◽  
P. Kavan ◽  
N. Aucoin ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Systemic Therapy ◽  
Systemic Treatment ◽  
Growth Factor Receptor ◽  
Retrospective Chart Review ◽  
First Line ◽  
Treatment Regimens ◽  
First Line Therapy ◽  
Epidermal Growth

Background Selection and sequencing of treatment regimens for individual patients with metastatic colorectal cancer (mcrc) is driven by maintaining reasonable quality of life and extending survival, as well as by access to and cost of therapies. The objectives of the present study were to describe, for patients with mcrc, attrition across lines of systemic therapy, patterns of therapy and their timing, and KRAS status.Methods A retrospective chart review at 6 Canadian academic centres included sequential patients who were diagnosed with mcrc from 1 January 2009 onward and who initiated first-line systemic treatment for mcrc between 1 January and 31 December 2009. Death was included as a competing risk in the analysis.Results The analysis included 200 patients who started first-line therapy. The proportions of patients who started second-, third-, and fourth-line systemic therapy were 70%, 30%, and 15% respectively. Chemotherapy plus bevacizumab was the most common first-line combination (66%). The most common first-line regimen was folfiri plus bevacizumab. KRAS testing was performed in 103 patients (52%), and 38 of 68 patients (56%, 19% overall) with confirmed KRAS wild-type tumours received an epidermal growth factor receptor inhibitor (egfri), which was more common in later lines. Most KRAS testing occurred after initiation of second-line therapy.Conclusions In the modern treatment era, a high proportion of patients receive at least two lines of therapy for mcrc, but only 19% receive egfri therapy. Earlier KRAS testing and therapy with an egfri might allow a greater proportion of patients to access all 5 active treatment agents.

scholarly journals Consensus on management of metastatic colorectal cancer in Central America and the Caribbean: San José, Costa Rica, August 2016

ESMO Open ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. e000315 ◽  
Author(s):  
Roberto Ivan López ◽  
Jenny Lissette Castro ◽  
Heidy Cedeño ◽  
Dagoberto Cisneros ◽  
Luis Corrales ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Epidermal Growth Factor Receptor ◽  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Metastatic Colorectal Cancer ◽  
Growth Factor Receptor ◽  
Primary Objective ◽  
First Line ◽  
Epidermal Growth ◽  
The Caribbean

Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women worldwide. In Latin America and the Caribbean, it has a mortality of 56%. The median overall survival for patients with metastatic colorectal cancer (mCRC) is currently estimated as ~30 months, which has substantially improved through strategic changes in treatment and in the management of patients. As opposed to other metastatic cancers where first-line regimens are often determined, mCRC requires special attention because there is controversy in the possible combinations of the available drugs and the different periods of duration for each patient. Each combination must seek to be effective and to generate the minimum adverse effects as possible. Instead of giving the first-line regimen until the tumour progresses, treatment is often individualised. Furthermore, up to 60% of colorectal tumours are considered non-mutated or wild-type CRC. Not harbouring mutations in the RAS family of genes or mutations in the signalling pathways of the epidermal growth factor receptor causes a null response to anti-epidermal growth factor receptor antibody therapy, which implies even more complex considerations regarding its management. The primary objective of this consensus is to address the main scenarios of mCRC in order to warrant the most appropriate therapeutic intervention for these patients in the Central American and the Caribbean (CAC) region. This can lead to better clinical outcomes as well as quality of life for palliative patients. This document includes the formal expert consensus recommendations for scenarios of mutated and non-mutated mCRC, including synchronous or metachronous disease, management of mCRC with liver and lung metastasis, resectable, potentially resectable or non-resectable tumours and local in the CAC context.

scholarly journals Metastatic Colorectal Cancer. First Line Therapy for Unresectable Disease

2020 ◽  
Vol 9 (12) ◽  
pp. 3889
Author(s):  
Jorge Aparicio ◽  
Francis Esposito ◽  
Sara Serrano ◽  
Esther Falco ◽  
Pilar Escudero ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Randomized Clinical Trials ◽  
Growth Factor Receptor ◽  
Current Evidence ◽  
Molecular Profile ◽  
First Line ◽  
Clinical Patient ◽  
First Line Therapy ◽  
Line Therapy

Colorectal cancer (CRC) is a commonly diagnosed malignancy. The prognosis of patients with unresectable, metastatic colorectal cancer (mCRC) is dismal and medical treatment is mainly palliative in nature. Although chemotherapy remains the backbone of treatment, the landscape is changing with the understanding of its heterogeneity and molecular biology. First-line therapy relies on a combination of chemotherapy and targeted therapies, according to clinical patient characteristics and tumor molecular profile. Here we review current evidence from randomized clinical trials for using chemotherapy doublets or triplets, and for the addition of bevacizumab or anti-epidermal growth factor receptor (EGFR) agents. Novel therapies developed for small, selected populations are also discussed.

scholarly journals Cost-Effectiveness of Anti-Epidermal Growth Factor Receptor Therapy Versus Bevacizumab in KRAS Wild-Type (WT), Pan-RAS WT, and Pan-RAS WT Left-Sided Metastatic Colorectal Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Shing Fung Lee ◽  
Horace C. W. Choi ◽  
Sik Kwan Chan ◽  
Ka On Lam ◽  
Victor H. F. Lee ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Epidermal Growth Factor Receptor ◽  
Cost Effectiveness ◽  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Metastatic Colorectal Cancer ◽  
Growth Factor Receptor ◽  
Wild Type ◽  
First Line ◽  
Epidermal Growth

ObjectivesWe aimed to compare the economic value of chemotherapy plus anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibody (mAb) against chemotherapy with bevacizumab (Bev, an anti-vascular endothelial growth factor mAb) as first-line treatment in KRAS wild-type (WT), pan-RAS WT and pan-RAS WT left-sided metastatic colorectal cancer (mCRC) patients from the Hong Kong societal perspective.Materials and MethodsWe developed Markov models and 10-year horizon to estimate costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) of chemotherapy plus anti-EGFR therapy against chemotherapy plus Bev in KRAS WT, pan-RAS WT, and pan-RAS WT left-sided mCRC. We considered two times of the local gross domestic product per capita (GDPpc) as the willingness-to-pay (WTP) threshold (2× GDPpc; US$97,832).ResultsAdding anti-EGFR mAb to chemotherapy provides additional 0.24 (95% confidence interval [CI] 0.19–0.29), 0.32 (95% CI 0.27–0.37), and 0.57 (95% CI 0.49–0.63) QALY compared to adding Bev in KRAS WT, pan-RAS WT, and left-sided pan-RAS WT mCRC populations respectively. The corresponding ICER is US$106,847 (95% CI 87,806–134,523), US$88,565 (95% CI 75,678–105,871), US$76,537 (95% CI 67,794–87,917) per QALY gained, respectively.ConclusionsAnti-EGFR therapy is more cost-effective than Bev as a first-line targeted therapy in left-sided pan-RAS WT and pan-RAS WT, with ICER <US$100,000/QALY, compared to KRAS WT mCRC population.

Effect of geographic distance from a cancer centre on choice of systemic therapy in metastatic colorectal cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17559-e17559
Author(s):  
M. D. Seal ◽  
G. R. Pond ◽  
T. Wilkieson ◽  
S. J. Hotte
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Travel Time ◽  
Systemic Therapy ◽  
Statistical Significance ◽  
Geographic Distance ◽  
Retrospective Chart Review ◽  
Full Data ◽  
Cancer Centre ◽  
Treatment Regimens

e17559 Background: There is little data on whether geographic distance from patient residence to a treatment facility is a predictor of systemic therapy utilization or clinical trial (CT) enrollment. Therefore a retrospective chart review was undertaken to investigate this variable. Methods: Consecutive patients with metastatic colorectal cancer (mCRC) assessed by a medical oncologist at the Juravinski Cancer Centre (JCC), Ontario during 2006 were selected. Patients with pathology other than adenocarcinoma and those with complete surgical resection of metastases were excluded. Distance and time to JCC were calculated using online mapping software. The study received full ethics approval. Results: 276 patients were included with full data available on 169 patients. Median travel time and distance to JCC were 23.0 minutes (min) and 19.2 kilometers (km), respectively. The maximum travel time was 120 min and 87% of patients lived within 60 min of JCC. Distance and time were highly correlated (p<0.0001). Overall, 43% of patients had discussed a CT with their oncologist and 20% enrolled in a CT. Patients living >50 km from JCC were less likely to discuss a CT (38%) or participate in a CT (15%) than patients who lived 25–50 km (39% and 19%) or <25 km (47% and 23%) from JCC. These trends did not attain statistical significance (odds ratio [OR] = 0.88, 95% CI = 0.66–1.17, p = 0.39 for CT discussion, OR = 0.76, 95% CI = 0.54–1.08, p = 0.13 for CT enrollment). Distance was not a statistically significant (p = 0.42) predictor of number of treatment regimens, however, 44% of patients <25 km from JCC received 3 or more lines of treatment compared with 33% of patients ≥25 km away. No association with survival was observed. Conclusions: Patients with mCRC living ≥25 km from JCC received fewer systemic regimens and were less likely to discuss or enter a CT. These trends were not statistically significant. Data collection is ongoing to increase the power of this study. No significant financial relationships to disclose.

Patterns in KRAS testing and EGFRi therapy across lines of treatment for metastatic colorectal cancer in Canada: A retrospective analysis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 665-665
Author(s):  
Hagen F. Kennecke ◽  
Jean Alfred Maroun ◽  
Petr Kavan ◽  
Nathalie Aucoin ◽  
Felix Couture ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Systemic Therapy ◽  
Retrospective Chart Review ◽  
Time Interval ◽  
Short Time Interval ◽  
Treatment Regimens ◽  
Study Sites ◽  
Short Time ◽  
Lost To Follow Up

665 Background: Selection and sequencing of treatment regimens for individual metastatic colorectal cancer (mCRC) patients is governed by the goals of maintaining reasonable quality of life while extending survival. The timing of KRAS testing and its effect on EGFRi therapy is poorly described. The goals of this analysis wereto describe rates and timing of KRAS testing relative to EGFRi therapy for Canadian patients diagnosed with mCRC. Methods: A retrospective chart review conducted at 6 Canadian centres included patients diagnosed with mCRC from Jan 1, 2009 onwards, who commenced 1st-line systemic treatment for mCRC between Jan 1–Dec 31, 2009. Information on the proportion of patients who received 2nd, 3rd, or subsequent lines of systemic therapy for mCRC was determined and the rates and timing of KRAS testing was ascertained. Results: 200 patients commenced 1st-line therapy and the median age was 62 yr; 78% had mCRC at the time of diagnosis. The proportions of patients who started 2nd, 3rd, and 4th lines of systemic therapy were 70%, 30%, and 15%, respectively. 103 (52%) patients had KRAS testing; 6%, 18%, 57%, 16%, 2%, and 1% of patients were tested at diagnosis or before the 2nd, 3rd, 4th, 5th and 6th lines of therapy, respectively. Median time from testing to EGFRi treatment was 105 (range, 7–1192) days, and varied by site. The frequency of KRAS testing for patients ranged from 30%–70% across study sites; across provinces, the frequency of testing ranged from 46%–60%. 38/68 (56%) of patients with wt KRAS tumors received EGFRi; 31 (46%) patients received EGFRi therapy as next therapy following KRAS testing. 19 (28%) died and 4 were lost to follow-up within 120 days of KRAS testing with no other therapy. 2 additional patients with unknown KRAS status received EGFRi (1 without KRAS testing; 1 undetermined). Conclusions: KRAS testing occurred after starting 2nd line in 76% of cases and varied by site and province. About half of patients underwent KRAS testing and 56% of those patients with wt KRAS tumors received an EGFRi. The short time interval between (K)RAS testing and EGFRi therapy may point to the need for earlier testing if EGFRi therapy is to be used in earlier lines of therapy.

scholarly journals Biomarker-Guided Anti-Egfr Rechallenge Therapy in Metastatic Colorectal Cancer

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1941
Author(s):  
Davide Ciardiello ◽  
Giulia Martini ◽  
Vincenzo Famiglietti ◽  
Stefania Napolitano ◽  
Vincenzo De Falco ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Current Knowledge ◽  
Growth Factor Receptor ◽  
Circulating Tumor Dna ◽  
Clinical Activity ◽  
First Line ◽  
First Line Therapy ◽  
Novel Biomarkers ◽  
Third Line

The prognosis of patients with metastatic colorectal cancer (mCRC) who progressed to the first and the second lines of treatment is poor. Thus, new therapeutic strategies are needed. During the last years, emerging evidence suggests that retreatment with anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (MAbs) in the third line of mCRC patients, that have previously obtained clinical benefit by first-line therapy with anti-EGFR MAbs plus chemotherapy, could lead to prolonged survival. The rationale beyond this “rechallenge” strategy is that, after disease progression to first line EGFR-based therapy, a treatment break from anti-EGFR drugs results in RAS mutant cancer cell decay, restoring the sensitivity of cancer cells to cetuximab and panitumumab. In fact, rechallenge treatment with anti-EGFR drugs has shown promising clinical activity, particularly in patients with plasma RAS and BRAF wild type circulating tumor DNA, as defined by liquid biopsy analysis at baseline treatment. The aim of this review is to analyze the current knowledge on rechallenge and to investigate the role of novel biomarkers that can guide the appropriate selection of patients that could benefit from this therapeutic strategy. Finally, we discuss on-going trials and future perspectives.

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