Influence of first line chemotherapy strategy depending on primary tumor location in metastatic colorectal cancer

Abstract

Background: Primary tumor location (PTL) is a major prognostic factor in metastatic colorectal cancer (mCRC) with left side which present better prognosis than right sided. Uncertainty exists regarding comparative effectiveness of irinotecan or oxaliplatin doublet in mCRC in function of PTL. Methods: We conducted a retrospective comparing clinical outcomes from both regimens in function of sidedness. Patients with newly diagnosed mCRC candidates to first-line chemotherapy were selected. Clinical outcomes were assessed and stratified by tumor location (left, right and rectal) and type of treatment. Results: Overall, 702 patients met the inclusion criteria. Primary colon cancer was right-sided in 248 (35.3%) patients, left-sided in 296 (42.2%) and rectal in 158 (22.5%) patients. Whatever PTL monochemotherapy give poor progression-free survival (PFS) and overall survival (OS). Triplet give better PFS and OS only for rectal cancer. When looking at doublet in first line. Folinic acid, 5FU, and irinotecan (FOLFIRI) give better PFS in rectal cancer [PFS of 21.2 (95% CI: 14.9-NR) versus 12.2 (95% CI: 10.1-13.4) months for the folinic acid, 5FU, and oxaliplatin (FOLFOX) group, P=0.009] and at trend for better PFS in right side tumor [14.9 (95% CI: 8.8-20.8) versus 11.3 (95% CI: 8.4-13.2) months for the FOLFOX group. P=0.0755]. No difference was observed in term of OS.Conclusions: our results support that either FOLFIRI or FOLFOX regimens give similar efficacy in both left and right metastatic colic cancer. FOLFIRI and FOLFIRINOX regimens might be preferred for metastatic rectal carcinoma.

Licochalcone C Inhibits the Growth of Human Colorectal Cancer HCT116 Cells Resistant to Oxaliplatin

“…In the USA, the incidence of CRC nearly doubled from 11% to 20% between 1995 and 2019, and by 2023, CRC is expected to be the cause of more than fifty thousand deaths. CRC can be treated with chemotherapy before or after surgery using 5-fluorouracil (5-FU), oxaliplatin (Ox), irinotecan, and other chemotherapeutics in combination with regimens such as FOLFOX, FOLFIRI, and FOLFRINOX ( Tharin et al ., 2021 ). Nonetheless, acquired resistance to these chemotherapies hampers CRC treatment and new strategies are needed to deal with resistance ( Martinez-Balibrea et al ., 2015 ).…”

Primary tumor location impacts survival in colorectal cancer patients after primary resection: a population‑based propensity score matching cohort study

“…Many scholars prefer surgical resection to improve patient prognosis ( 10 ), while others hold the opposite view ( 11 ). Moreover, the primary tumor location (PLT) may also affect the choice of chemotherapy strategy ( 12 ). This study analyzed the role of primary site resection in the management of unresectable liver metastases based on extensive evidence-based medical data from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute.…”

Is red blood cell distribution width a prognostic factor for colorectal cancer? A meta-analysis

“…The treatments of CRC include surgery, chemotherapy, radiotherapy, surgery, targeted therapy and immunotherapy (3)(4)(5)(6)(7)(8). Nowadays, radical surgery is the cornerstone treatment of CRC (9,10), which not only can treat cancer, but also help in the improvement of some comorbidities (11,12).…”