Baseline and On-Treatment Markers Determining Prognosis of First-Line Chemotherapy in Combination with Bevacizumab in Patients with Metastatic Colorectal Cancer

Abstract

Background: In metastatic colorectal cancer, no upfront or on-treatment markers are available to determine the prognosis or efficacy for chemotherapy in combination with bevacizumab. Patients and Methods: The current analysis was performed to evaluate the prognostic value of disease and patient characteristics (age, number of metastatic sites, stage of primary tumor, performance status, carcinoembryonic antigen (CEA)) and on-treatment changes of CEA (response after 8-12 weeks of treatment and specific patterns of CEA kinetics) in patients from an observational cohort study of chemotherapy with bevacizumab. Results: Baseline factors were available from 1,438 patients. Patients with baseline CEA levels > 20 ng/ml, more than 1 metastatic site, and age > 75 years showed significantly lower progression-free (PFS) and overall survival in multivariate analysis. A CEA response of > 30% during treatment was associated with increased PFS. In addition, the pattern of CEA kinetics predicts survival and response to treatment. Conclusion: In summary, baseline CEA, number of metastatic sites, and age are strong independent prognostic factors for survival. By monitoring CEA, clear patterns with distinct prognostic value can be determined. CEA kinetics and/or response after 8-12 weeks might be a useful and simple tool to stratify the post-induction treatment approach based on individual prognosis in the future.

Targeted Therapy in the Palliative Setting of Colorectal Cancer—Survival and Medical Costs

“…In line with previous studies, a poor performance status [23,24], high CEA levels at baseline [25,26], right-sided colorectal cancer [23,27], and the presence of liver metastases [24] were correlated with shorter overall survival. Of note, we acknowledge that the effects of performance status may be under-estimated in our study, since when information about ECOG PS was lacking and symptoms were present, the ECOG PS score was set to no more than 1.…”

“…Age was not a predictor of overall survival in this study. Conflicting results on whether age is a predictor of overall survival in metastatic colorectal cancer have been reported in previous studies and are most likely dependent on how the age groups are defined, whether age is assessed as a categorical or a continuous variable, and the number of patients in respective age groups [26,29,30]. Large-scale studies show that the risk of death seems to be highest among the youngest and oldest patients compared to middle-aged patients with metastatic colorectal cancer [30].…”

Increased serum pentraxin-3 level predicts poor prognosis in patients with colorectal cancer after curative surgery, a cohort study

“…[ 1 , 2 ] Despite improvements of surgical techniques and adjuvant therapies and implementation of comprehensive standard treatments, the overall prognosis of CRC patients still poor. [ 3 – 5 ] High morbidity of metastasis and relapse were considered as main contributors to unsatisfactory long-term prognosis for CRC patients underwent standard treatments. [ 6 , 7 ] It has been revealed both inflammation and immunity dysregulation was closely associated with proliferation and migration of tumor cells.…”