Real-World Effect of Maintenance and Intermittent Chemotherapy on Survival in Metastatic Colorectal Cancer

Loree, Jonathan M.; Tan, Sean K. R.; Lafond, Laurence; Speers, Caroline; Kennecke, Hagen F.; Cheung, Winson Y.

doi:10.1016/j.clcc.2017.10.011

Cited by 14 publications

(11 citation statements)

References 11 publications

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“…In this prospectively‐collected, multisite observational study of patients diagnosed with metastatic CRC, the median OS time from diagnosis of metastatic disease was 2.5 years, which compares favorably with other contemporary real‐world series 25‐27 . Encouragingly, it is also comparable to findings in the recent prospective randomized trial of regorafenib versus placebo for patients with mCRC refractory to all other standard systemic therapies, where overall median survivals were approximately 3 years (37.4 months in regorafenib group and 34.9 months in placebo group) 19 .…”

Section: Discussionsupporting

confidence: 71%

“…In this prospectively-collected, multisite observational study of patients diagnosed with metastatic CRC, the median OS time from diagnosis of metastatic disease was 2.5 years, which compares favorably with other contemporary real-world series. [25][26][27] Encour- Interestingly, survival post-metastasectomy seemed to be similar when comparing liver against nonliver anatomical site of metastasis.…”

Section: Discussionmentioning

confidence: 97%

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Trends in epidemiology, treatment and molecular testing of metastatic colorectal cancer in a real‐world multi‐institution cohort study

Kuchel

Ahern

Collins

et al. 2020

Asia-Pac J Clncl Oncology

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Aim Colorectal cancer (CRC) is the third most common cancer in Australia, and survival after diagnosis of metastatic disease is improving. Our aim was to assess trends in epidemiology, treatment, molecular testing and survival in patients with metastatic CRC (mCRC). Methods Clinical data from February 2013 to December 2018 was recorded in a prospective, observational, multicenter cohort study conducted in Queensland, Australia, examining clinical and molecular biomarkers in cases of mCRC. Results A total of 159 patients who had metastasis diagnosed after February 2013 were included in survival analysis. Median age at diagnosis was 63.9 years, but 29% had early‐onset disease (diagnosis aged <50 years). Median overall survival was 2.5 years (95% confidence interval [CI], 2.2–3.0) for the 159 patients included in survival analysis. Independent factors correlated with poor prognosis included right‐sided primary tumor, neutrophil–lymphocyte ratio >5, increased alkaline phosphatase level (ALP) and an increasing number of sites of metastatic disease. In contrast, metastasectomy was associated with improved overall survival (adjusted HR = 0.29’ 95% CI, 0.16–0.54), with similar survival between patients who had liver and non‐liver metastasectomy sites. Half (10/20) of the BRAF mutant CRC were also microsatellite unstable. The proportion of detected mutations amongst tested samples increased over time for Kirsten Rat Sarcoma (KRAS; OR [per year] = 1.19; 95% CI, 1.01–1.39). Concurrently, the methods of molecular genetics testing employed in routine clinical practice changed towards the adoption of next‐generation sequencing. Conclusions Metastasectomy in mCRC may be beneficial regardless of the anatomical site of metastasis. The adoption of next‐generation sequencing techniques for molecular genetics testing coincided with a slightly increased rate of detection of KRAS and BRAF mutations, potentially reflecting greater test sensitivity. Further translational research is required in mCRC to define novel targets for treatment.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 97%

Trends in epidemiology, treatment and molecular testing of metastatic colorectal cancer in a real‐world multi‐institution cohort study

Kuchel

Ahern

Collins

et al. 2020

Asia-Pac J Clncl Oncology

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“…Maintenance chemotherapy (MC), one of the chemotherapy strategies that includes continuation and switch maintenance, aims to prolong the duration of the response and maintain a quality of life that generally uses a well-tolerated, single-agent regimen of chemotherapy as continued therapy [8]. MC was originated for hematologic malignancies and applied subsequently for several metastatic solid tumors, such as lung and colorectal cancer [8–10]. MC has been reported to achieve a satisfactory high response rate and superior survival in NPC patients with distant metastasis (DM) as well [11, 12].…”

Section: Introductionmentioning

confidence: 99%

Maintenance chemotherapy using S-1 following definitive chemoradiotherapy in patients with N3 nasopharyngeal carcinoma

et al. 2019

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BackgroundPatients with N3 stage nasopharyngeal carcinoma (NPC) are at high risk for treatment failure. This study aims to assess the efficacy of maintenance chemotherapy (MC) using S-1 (MC-S1), a novel oral fluoropyrimidine agent, following definitive chemoradiotherapy (CRT) using intensity-modulated radiotherapy (IMRT) in patients with N3 nasopharyngeal carcinoma (N3-NPC).MethodsA retrospective review was conducted for all N3-NPC treated with CRT with MC (CRT-MC) or without MC (CRT-non-MC) during 2014–2016. Toxicities with MC were recorded. Overall survival (OS), locoregional failure-free survival (LFFS) and distant metastasis free survival (DMFS) were compared between CRT-MC vs. CRT-non-MC cohorts.ResultsA total of 130 N3 patients were identified, of whom 21 (16.2%) were treated with CRT-MC, and 109 (83.8%) with CRT-non-MC. Patient characteristics did not significantly differ between the CRT-MC and CRT-non-MC groups, with the exception of the number of cycles of neoadjuvant chemotherapy. Following IMRT 69 patients achieved a complete response (CR) (CRT-MC: 10; CRT-non-MC: 59), 61 had a partial response (PR) (11 vs. 50), and none maintained stable disease (SD) or developed progression of disease (PD). After a median follow-up of 41 months for surviving patients, a significant differences in OS (76.3% vs. 95.2%, p = 0.046) and DMFS (70.3% vs. 90.5%, p = 0.043) but not LFFS (84.9% vs. 100%, p = 0.091) at 3 years were observed between the CRT-non-MC and CRT-MC groups. Skin hyperpigmentation, leucopenia, fatigue, neutropenia, anorexia and nausea were the common but not severe (grade 1–2) toxicities of MC.ConclusionsUsing MC-S1 in N3-NPC patients following IMRT achieved superior survival to the CRT-non-MC patients. The toxicities of MC-S1 were mild and tolerable. Further clinical trials are required to evaluate the efficacy of MC-S1 in N3-NPC patients.

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“…In a retrospective analysis of 617 patients with mCRC, Loree et al [33] showed that patients treated with intermittent or maintenance therapy lived longer than did those treated with continuous therapy (40 or 36 vs. 20 months, respectively). They also investigated whether retreatment with the same agent at progression or continuous therapy improved the OS, with evidence in favor of the first group of patients [32].…”

Section: Plos Onementioning

confidence: 99%

Partnering bevacizumab with irinotecan as first line-therapy of metastatic colorectal cancer improves progression free survival-A retrospective analysis

et al. 2021

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Colorectal cancer remains one of the most frequent malignancies (third place at both genders) worldwide in the last decade, owing to significant changes in modern dietary habits. Approximately half of the patients develop metastases during the course of their disease. The available therapeutic armamentarium is constantly evolving, raising questions regarding the best approach for improving survival. Bevacizumab remains one of the most widely used therapies for treating metastatic colorectal cancer and can be used after progression. This study aimed to identify the best chemotherapy partner for bevacizumab after progression. We performed a retrospective analysis of patients with metastatic colorectal cancer who were treated with bevacizumab as first- and second-line chemotherapy. Data were collected for 151 patients, 40 of whom were treated with double-dose bevacizumab after the first progression. The two standard chemotherapy regimens combined with bevacizumab were FOLFIRI/CAPIRI and FOLFOX4/CAPEOX. The initiation of first-line treatment with irinotecan-based chemotherapy improved progression-free survival and time to treatment failure but not overall survival. After the first progression, retreatment with the same regimen as that used in the induction phase was the best approach for improving overall survival (median overall survival: 46.5 vs. 27.0 months for the same vs. switched strategy, respectively). No correlations were observed between the dose intensity of irinotecan, oxaliplatin, 5-fluorouracil, or bevacizumab and the overall survival, progression-free survival in the first-/second-line treatment, and time to treatment failure. Interaction between an irinotecan-based regimen as a second-line treatment and double-dose bevacizumab after progression was associated with an improved overall survival (p = 0.06). Initiating systemic treatment with an irinotecan-based regimen in combination with bevacizumab improved the progression-free survival in the first-line treatment and time to treatment failure. In terms of overall survival, bevacizumab treatment after the first progression is better partnered with the same regimen as that used in the induction phase.

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Real-World Effect of Maintenance and Intermittent Chemotherapy on Survival in Metastatic Colorectal Cancer

Cited by 14 publications

References 11 publications

Trends in epidemiology, treatment and molecular testing of metastatic colorectal cancer in a real‐world multi‐institution cohort study

Trends in epidemiology, treatment and molecular testing of metastatic colorectal cancer in a real‐world multi‐institution cohort study

Maintenance chemotherapy using S-1 following definitive chemoradiotherapy in patients with N3 nasopharyngeal carcinoma

Partnering bevacizumab with irinotecan as first line-therapy of metastatic colorectal cancer improves progression free survival-A retrospective analysis

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