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Boyne DJ, Ngan E, Carbonell C, Wani RJ, Cirone Morris C, Martinez DJ, Cheung WY. Real-World Study to Assess Patterns of Treatment Practices and Clinical Outcomes in Metastatic Colorectal Cancer Patients with RAS Wild-Type Left-Sided Tumours in Canada. Curr Oncol 2023; 30:8220-8232. [PMID: 37754511 PMCID: PMC10528146 DOI: 10.3390/curroncol30090596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023] Open
Abstract
Minimal Canadian data are available on the RAS testing rates, treatment patterns, and corresponding overall survival (OS) in metastatic colorectal cancer (mCRC) patients. We conducted a population-based cohort study of left-sided RAS wild-type (WT) mCRC patients diagnosed between 1 January 2014 and 31 December 2019, and who were treated with first-line (1L) chemotherapy plus the epidermal growth factor receptor inhibitor panitumumab, chemotherapy plus bevacizumab, or chemotherapy alone, in Alberta, Canada, using electronic medical records and administrative health system data. Of the 2721 patients identified with left-sided mCRC, 320 patients with RAS WT mCRC were treated with 1L systemic therapy: chemotherapy plus panitumumab (n = 64), chemotherapy plus bevacizumab (n = 52), or chemotherapy alone (n = 204). Only 65% and 39% of the 320 1L-treated patients initiated second- and third-line therapy, respectively. A total of 71% of individuals with treated left-sided mCRC underwent RAS testing. The median OS for mCRC patients with RAS WT left-sided tumours was higher for patients treated with 1L panitumumab plus chemotherapy (34.3 months; 95% CI: 23.8-39.6) than for patients who received 1L chemotherapy alone (30.0 months; 95% CI: 24.9-34.1) or 1L bevacizumab plus chemotherapy (25.6 months; 95% CI: 21.2-35.7). These findings highlight an unmet need in left-sided RAS WT mCRC, with relatively few individuals receiving a biologic agent in combination with chemotherapy in the 1L setting, a high rate of attrition between lines, and a need for increased RAS testing before treatment initiation.
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Affiliation(s)
- Devon J. Boyne
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (C.C.); (W.Y.C.)
| | - Elaine Ngan
- Amgen Canada Inc., Mississauga, ON L5N 0A4, Canada; (E.N.); (R.J.W.); (C.C.M.); (D.J.M.)
| | - Chantelle Carbonell
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (C.C.); (W.Y.C.)
| | - Rajvi J. Wani
- Amgen Canada Inc., Mississauga, ON L5N 0A4, Canada; (E.N.); (R.J.W.); (C.C.M.); (D.J.M.)
| | - Carlye Cirone Morris
- Amgen Canada Inc., Mississauga, ON L5N 0A4, Canada; (E.N.); (R.J.W.); (C.C.M.); (D.J.M.)
| | - Daniel Jun Martinez
- Amgen Canada Inc., Mississauga, ON L5N 0A4, Canada; (E.N.); (R.J.W.); (C.C.M.); (D.J.M.)
| | - Winson Y. Cheung
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (C.C.); (W.Y.C.)
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
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Kasper S, Foch C, Esser R, Lamy FX, Zhang A, Cheng AL, Rouyer M, Brodowicz T, Zielinski C. Overall survival with cetuximab every-2-weeks versus standard once-weekly administration schedule for first-line treatment of RAS wild-type metastatic colorectal cancer in patients with left- and right-sided primary tumour location. Eur J Cancer 2023; 180:85-88. [PMID: 36563490 DOI: 10.1016/j.ejca.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Stefan Kasper
- West German Cancer Centre, University Hospital Essen, University of Duisburg-Essen, Germany.
| | | | | | | | - Aimar Zhang
- Merck Serono (Beijing) Pharmaceutical R&D Co., Ltd, Beijing, China
| | - Ann-Lii Cheng
- National Taiwan University Cancer Center, Taipei, Taiwan
| | - Magali Rouyer
- Bordeaux PharmacoEpi, INSERM CIC1401, University of Bordeaux, Bordeaux, France
| | - Thomas Brodowicz
- Internal Medicine, Vienna General Hospital and Medical University of Vienna, Austria
| | - Christoph Zielinski
- Comprehensive Cancer Centre, Vienna General Hospital and Medical University of Vienna, Austria
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3
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Hamfjord J, Myklebust TÅ, Larsen IK, Kure EH, Glimelius B, Guren TK, Tveit KM, Guren MG. Survival Trends of Right- and Left-Sided Colon Cancer across Four Decades: A Norwegian Population-Based Study. Cancer Epidemiol Biomarkers Prev 2022; 31:342-351. [PMID: 34853022 PMCID: PMC9398128 DOI: 10.1158/1055-9965.epi-21-0555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/03/2021] [Accepted: 11/23/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Patients with right-sided colon cancer (RCC) and left-sided colon cancer (LCC) differ clinically and molecularly. The main objective was to investigate stage-stratified survival and recurrence of RCC and LCC across four 10-year periods. METHODS Patients diagnosed from 1977 to 2016 with colon adenocarcinoma were included from the Cancer Registry of Norway. Primary tumor location (PTL) was defined as RCC if proximal and LCC if distal to the splenic flexure. Multivariable regressions were used to estimate HRs for overall survival (OS), recurrence-free survival (RFS), survival after recurrence (SAR), and excess HRs (eHR) for relative survival (RS). RESULTS 72,224 patients were eligible for analyses [55.1% (n = 39,769/72,224) had RCC]. In 1977 to 1986, there was no difference between LCC and RCC in OS [HR, 1.01; 95% confidence interval (CI), 0.97-1.06; P = 0.581] or RS (eHR, 0.96; 95% CI, 0.90-1.02; P = 0.179). In 2007 to 2016, LCC had significantly better OS (HR, 0.84; 95% CI, 0.80-0.87; P < 0.001) and RS (eHR, 0.76; 95% CI, 0.72-0.81; P < 0.001) compared with RCC. The gradually diverging and significantly favorable prognosis for LCC was evident for distant disease across all time periods and for regional disease from 2007 onward. There was no difference in RFS between LCC and RCC in patients less than 75 years during 2007 to 2016 (HR, 0.99; 95% CI, 0.91-1.08; P = 0.819); however, SAR was significantly better for LCC (HR, 0.61; 95% CI, 0.53-0.71; P < 0.001). CONCLUSIONS A gradually diverging and increasingly favorable prognosis was observed for patients with LCC with advanced disease over the past four decades. IMPACT Current PTL survival disparities stress the need for further exploring targetable molecular subgroups across and within different PTLs to further improve patient outcomes.
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Affiliation(s)
- Julian Hamfjord
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Registration, Cancer Registry of Norway, Oslo, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | | | - Elin H. Kure
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,Faculty of Technology, Natural Sciences and Maritime Sciences, University of South-Eastern Norway, Bø in Telemark, Norway
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Tormod K. Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Kjell M. Tveit
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianne G. Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Corresponding Author: Marianne G. Guren, Department of Oncology, Oslo University Hospital, P.O. Box 4956 Nydalen, Oslo N-0424, Norway. E-mail:
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4
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Kasper S, Foch C, Messinger D, Esser R, Lamy FX, Rothe V, Chen W, Cheng AL, Rouyer M, Brodowicz T, Zielinski C. Noninferiority of cetuximab every-2-weeks versus standard once-weekly administration schedule for the first-line treatment of RAS wild-type metastatic colorectal cancer. Eur J Cancer 2021; 144:291-301. [PMID: 33383349 DOI: 10.1016/j.ejca.2020.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 02/08/2023]
Abstract
AIM This study assessed whether cetuximab 500 mg/m2 administered every 2 weeks (Q2W), when combined with chemotherapy as a first-line (1L) treatment, was noninferior to the approved dose (400 mg/m2 followed by 250 mg/m2 once weekly [Q1W]) for overall survival (OS) in adults with RAS wild-type metastatic colorectal cancer (mCRC). METHODS This pooled analysis included patients receiving 1L treatment with cetuximab Q1W or Q2W in combination with chemotherapy from post-authorisation studies with patient-level data available to the sponsor. Baseline characteristics were adjusted with a propensity score using inverse probability of treatment weighting (IPTW). Noninferiority in terms of OS was tested with a noninferiority margin for the hazard ratio (HR) of 1.25 using a Cox proportional hazards regression model. Secondary outcomes were progression-free survival (PFS), overall response rate (ORR) and rates of lung/liver metastases resection and serious adverse events. RESULTS OS time was noninferior in the Q2W cohort (n = 554) compared to the Q1W cohort (n = 763), with a HR after IPTW (95% confidence interval) of 0.827 (0.715-0.956) and median OS times of 24.7 (Q1W) and 27.9 (Q2W) months. There were no major differences in PFS (HR: 0.915 [0.804-1.042]). The odds ratios (ORs) after IPTW for ORR (1.292 [1.031-1.617]) and the rates of lung/liver metastases resection (1.419 [1.043-1.932]) favoured the Q2W regimen. No differences were noted in the occurrence rate of any SAE between groups; the OR after IPTW was 1.089 (0.858-1.382). CONCLUSIONS The cetuximab Q2W regimen was noninferior to the Q1W regimen for OS in the 1L treatment of mCRC.
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Affiliation(s)
- Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.
| | | | | | | | | | | | | | - Ann-Lii Cheng
- National Taiwan University Cancer Center, Taipei, Taiwan
| | - Magali Rouyer
- Bordeaux PharmacoEpi, INSERM CIC1401, University of Bordeaux, Bordeaux, France
| | - Thomas Brodowicz
- Department of Medical Oncology, Internal Medicine 1, General Hospital - Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Department of Medical Oncology, Internal Medicine 1, General Hospital - Medical University of Vienna, Vienna, Austria
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5
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Han J, Xiao D, Tan C, Zeng X, Hu H, Zeng S, Jiang Q, She L, Yao L, Li L, Tang L, Ma J, Huang J, Shen L. Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal Cancer. Cancer Control 2020; 27:1073274820902271. [PMID: 32107929 PMCID: PMC7053788 DOI: 10.1177/1073274820902271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The FIRE-3 phase III clinical trial demonstrated the marked advantage of prolonging the median overall survival of patients with final RAS wild-type (WT) left-sided metastatic colorectal cancer (mCRC) by 38.3 months after treatment with irinotecan, fluorouracil, and leucovorin (FOLFIRI) plus cetuximab and by 28.0 months after treatment with FOLFIRI plus bevacizumab. However, the substantial cost increase and economic impact of using cetuximab imposes a considerable burden on patients and society. METHODS A Markov model based on the data collected in the FIRE-3 trial was developed to investigate the cost-effectiveness of treating patients with FOLFIRI plus either cetuximab or bevacizumab from the perspective of the Chinese health-care system. Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated over a lifetime horizon. One-way and probabilistic sensitivity analyses were performed by varying potentially modifiable parameters. RESULTS In our analysis, the total treatment costs in the bevacizumab and cetuximab groups were $92 549.31 and $94 987.31, respectively, and the QALYs gained were 1.58 and 2.05. In the base-case analysis, compared with bevacizumab, left-sided RAS WT patients receiving cetuximab gained 0.47 more QALYs at an ICER of $5187.23/QALY ($3166.23/LY). The 1-way sensitivity analysis showed that the most influential parameter was the cost of cetuximab. Probabilistic sensitivity analysis indicated that the cost-effective probability of cetuximab group was 92.8% under the willingness-to-pay threshold of $24 081. CONCLUSIONS Treatment with FOLFIRI plus cetuximab in Chinese patients with left-sided RAS WT mCRC may improve health outcomes and use financial resources more efficiently than FOLFIRI plus bevacizumab.
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Affiliation(s)
- Jiaqi Han
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Desheng Xiao
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Chongqing Tan
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaohui Zeng
- PET-CT Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Huabin Hu
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shan Zeng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Qin Jiang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Longjiang She
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Linli Yao
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Li Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Lanhua Tang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Ma
- Cancer Research Institute, Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Central South University, Changsha, China
| | - Jin Huang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
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6
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Young S, Golzarian J. Primary Tumor Location in Colorectal Cancer: Comparison of Right- and Left-Sided Colorectal Cancer Characteristics for the Interventional Radiologist. Cardiovasc Intervent Radiol 2018; 41:1819-1825. [PMID: 29946943 DOI: 10.1007/s00270-018-2014-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/14/2018] [Indexed: 01/01/2023]
Abstract
One area which has emerged as an important factor for predicting molecular profile and treatment outcomes in metastatic colorectal cancer (mCRC) is primary tumor location. The importance of molecular characteristics of colorectal cancer has been firmly established in terms of prognosis and treatment algorithms for many years. Recent studies have also suggested that molecular profiles are important in locoregional therapies as well, with some data suggesting changes in treatment algorithms based on tumor location. Therefore, it is important for interventional radiologists to understand the basic molecular characteristics and development pathways of mCRC. Here, these disease characteristics are reviewed and the differences in left- versus right-sided primary tumor location are explored.
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Affiliation(s)
- Shamar Young
- Department of Radiology, University of Minnesota, 420 Delaware St SE, MMC 292, Minneapolis, MN, 55455, USA.
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota, 420 Delaware St SE, MMC 292, Minneapolis, MN, 55455, USA
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7
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Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, Heinemann V, Van Cutsem E, Pignon JP, Tabernero J, Cervantes A, Ciardiello F. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol 2018; 28:1713-1729. [PMID: 28407110 DOI: 10.1093/annonc/mdx175] [Citation(s) in RCA: 562] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background There is increasing evidence that metastatic colorectal cancer (mCRC) is a genetically heterogeneous disease and that tumours arising from different sides of the colon (left versus right) have different clinical outcomes. Furthermore, previous analyses comparing the activity of different classes of targeted agents in patients with KRAS wild-type (wt) or RAS wt mCRC suggest that primary tumour location (side), might be both prognostic and predictive for clinical outcome. Methods This retrospective analysis investigated the prognostic and predictive influence of the localization of the primary tumour in patients with unresectable RAS wt mCRC included in six randomized trials (CRYSTAL, FIRE-3, CALGB 80405, PRIME, PEAK and 20050181), comparing chemotherapy plus EGFR antibody therapy (experimental arm) with chemotherapy or chemotherapy and bevacizumab (control arms). Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and progression-free survival (PFS) for patients with left-sided versus right-sided tumours, and odds ratios (ORs) for objective response rate (ORR) were estimated by pooling individual study HRs/ORs. The predictive value was evaluated by pooling study interaction between treatment effect and tumour side. Results Primary tumour location and RAS mutation status were available for 2159 of the 5760 patients (37.5%) randomized across the 6 trials, 515 right-sided and 1644 left-sided. A significantly worse prognosis was observed for patients with right-sided tumours compared with those with left-sided tumours in both the pooled control and experimental arms for OS [HRs = 2.03 (95% CI: 1.69-2.42) and 1.38 (1.17-1.63), respectively], PFS [HRs = 1.59 (1.34-1.88) and 1.25 (1.06-1.47)], and ORR [ORs = 0.38 (0.28-0.50) and 0.56 (0.43-0.73)]. In terms of a predictive effect, a significant benefit for chemotherapy plus EGFR antibody therapy was observed in patients with left-sided tumours [HRs = 0.75 (0.67-0.84) and 0.78 (0.70-0.87) for OS and PFS, respectively] compared with no significant benefit for those with right-sided tumours [HRs = 1.12 (0.87-1.45) and 1.12 (0.87-1.44) for OS and PFS, respectively; P value for interaction <0.001 and 0.002, respectively]. For ORR, there was a trend (P value for interaction = 0.07) towards a greater benefit for chemotherapy plus EGFR antibody therapy in the patients with left-sided tumours [OR = 2.12 (1.77-2.55)] compared with those with right-sided tumours [OR = 1.47 (0.94-2.29)]. Exclusion of the unique phase II trial or the unique second-line trial had no impact on the results. The predictive effect on PFS may depend of the type of EGFR antibody therapy and on the presence or absence of bevacizumab in the control arm. Conclusion This pooled analysis showed a worse prognosis for OS, PFS and ORR for patients with right-sided tumours compared with those with left-sided tumours in patients with RAS wt mCRC and a predictive effect of tumour side, with a greater effect of chemotherapy plus EGFR antibody therapy compared with chemotherapy or chemotherapy and bevacizumab, the effect being greatest in patients with left-sided tumours. These predictive results should be interpreted with caution due to the retrospective nature of the analysis, which was carried out on subpopulations of patients included in these trials, and because none of these studies contemplated a full treatment sequence strategy.
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Affiliation(s)
- D Arnold
- Institute of Oncology, CUF Hospitals, Lisbon, Portugal
| | - B Lueza
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | | | - M Peeters
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | - H-J Lenz
- Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles
| | - A Venook
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
| | - V Heinemann
- Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximillans-Universität, Munich, Germany
| | - E Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - J-P Pignon
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | - J Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain and CIBERONC, Institute of Health Carlos III, Madrid
| | - A Cervantes
- Department of Medical Oncology, Biomedical Health Research Institute INCLIVA, University of Valencia, Valencia.,CIBERONC, Institute of Health Carlos III, Madrid, Spain
| | - F Ciardiello
- Division of Medical Oncology, Department of Experimental and Clinical Medicine and Surgery "F. Magrassi and A. Lanzara", Second University of Naples, Naples, Italy
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Modest DP, Stintzing S, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, Heintges T, Kahl C, Seipelt G, Kullmann F, Scheithauer W, Moehler M, Holch JW, von Einem JC, Held S, Heinemann V. Exploring the effect of primary tumor sidedness on therapeutic efficacy across treatment lines in patients with metastatic colorectal cancer: analysis of FIRE-3 (AIOKRK0306). Oncotarget 2017; 8:105749-105760. [PMID: 29285289 PMCID: PMC5739676 DOI: 10.18632/oncotarget.22396] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/13/2017] [Indexed: 12/22/2022] Open
Abstract
Purpose To assess the impact of primary tumor sidedness on outcome of patients with metastatic colorectal cancer (mCRC) across treatment lines. Patients and Methods Patients of the FIRE-3 trial (initial FOLFIRI plus either cetuximab or bevacizumab) were separately evaluated according to primary tumor site differentiating left-sided (LPT) from right-sided primary tumors (RPT). Efficacy (i.e. progression-free survival (PFS2nd) and overall survival (OS2nd) of second-line therapy) was evaluated by Kaplan-Meier method and compared by log rank test as well as Cox regression analyses. All analyses were also reported according to drug sequences. Results 411 of 592 patients (69%) with KRAS exon 2 wild-type tumors received 2nd-line therapy has and had available information on primary tumor location, of those 309 patients (75%) presented with LPT. In patients with LPT, PFS2nd was markedly longer than in patients with RPT (6.0 months [95% CI 5.5-6.5] versus 3.8 months [95% CI 2.5-5.2], hazard ratio: 0.61 [95% CI 0.47-0.78], P<0.001). Differences in PFS2nd between study-arms were evident in patients with LPT, but not in patients with RPT (Cox model interaction test, P=0.12). Consistent observations were also made for OS2nd. Conclusion This retrospective analysis of FIRE-3 indicates that efficacy of second-line therapy was significantly greater in patients with left-sided tumors as compared to right-sided tumors. This difference was driven by superior activity of second-line regimens of the initial cetuximab-arm as compared to the initial bevacizumab-arm in left-sided tumors. Our observations confirm the strong prognostic value of primary tumor location in second-line therapy of mCRC.
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Affiliation(s)
- Dominik Paul Modest
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Sebastian Stintzing
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | | | | - Alexander Kiani
- Medizinische Klinik IV, Klinikum Bayreuth, Bayreuth, Germany
| | | | - Salah-Eddin Al-Batran
- Department of Hematology and Oncology, Krankenhaus Nordwest Frankfurt/Main, Frankfurt, Germany
| | - Tobias Heintges
- Department of Medicine II, Städtisches Klinikum Neuss, Neuss, Germany
| | - Christoph Kahl
- Haematology and Oncology, Staedtisches Klinikum Magdeburg, Magdeburg, Germany
| | | | - Frank Kullmann
- Department of Medicine I, Klinikum Weiden, Weiden in der Oberpfalz, Germany
| | - Werner Scheithauer
- Department of Internal Medicine I & Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Markus Moehler
- Medical Department 1, Johannes-Gutenberg Universität Mainz, Mainz, Germany.,University Cancer Center Frankfurt/Mainz and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Julian Walter Holch
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Jobst Christian von Einem
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | | - Volker Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
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