Impact of Biomarkers and Primary Tumor Location on the Metastatic Colorectal Cancer First-Line Treatment Landscape in Five European Countries

Abstract

Background: Advances in therapies for patients with metastatic colorectal cancer (mCRC) and improved understanding of prognostic and predictive factors have impacted treatment decisions. Materials & methods: This study used a large oncology database to investigate patterns of monoclonal antibody (mAb) plus chemotherapy treatment in France, Germany, Italy, Spain and the UK in mCRC patients treated in first line in 2018. Results: Anti-EGFR mAbs were most often administered to patients with RAS wild-type mCRC and those with left-sided tumors, while anti-VEGF mAbs were preferred in RAS mutant and right-sided tumors. Adopted treatment strategies differed between countries, largely due to reimbursement. Conclusion: Biomarker status and primary tumor location steered treatment decisions in first line. Adopted treatment strategies differed between participating countries.

The Screening and COnsensus Based on Practices and Evidence (SCOPE) Program Results of a Survey on Daily Practice Patterns for Patients with Metastatic Colorectal Cancer—A Swiss Perspective in the Context of an International Viewpoint

“…However, this overlap was not complete, and such variability may be a result of limited access to proper diagnostic equipment or subsequent treatment options. Interestingly, these results align with a 2018 study designed to capture 1L treatment patterns of mCRC patients in real-world clinical practices in five European countries (France, Germany, Italy, Spain, and the United Kingdom) [ 14 ]. In that study, despite tumor-sidedness and biomarker status being the main drivers of (1L) treatment selection, they were not consistently incorporated into mCRC patient regimens.…”

“…In that study, despite tumor-sidedness and biomarker status being the main drivers of (1L) treatment selection, they were not consistently incorporated into mCRC patient regimens. The finally adopted treatment strategies varied considerably between countries, testifying reimbursement issues as one of the primary barriers [ 14 ]. Thus, the variations in decision-making showed in our study may be explained by reimbursement and other health system socioeconomic issues, which is also supported by other studies [ 15 , 16 ].…”

Real-World Outcomes in Patients with Metastatic Colorectal Cancer in Spain: The RWD-ACROSS Study

“…Similarly, in the abovementioned 2016–2017 Spanish study, biologics were added to chemotherapy as first-line treatment for 61.4% of patients (mainly anti-VEGF (38.8% of patients) and anti-EGFR agents (22%)) [ 25 ]. Another European study, by Kafatos and colleagues, of first-line treatment in 2018 of patients with mCRC for whom RAS and BRAF status was known, reported that 81.0% of patients with wild-type RAS tumors received a biologic agent (anti-EGFR + chemotherapy 62.6% of patients; anti-VEGF + chemotherapy 18.4% of patients), whereas 19.0% received chemotherapy alone [ 27 ]. A biologic agent was received by 61.9% of patients with mutated RAS tumors [ 27 ].…”

“…Another European study, by Kafatos and colleagues, of first-line treatment in 2018 of patients with mCRC for whom RAS and BRAF status was known, reported that 81.0% of patients with wild-type RAS tumors received a biologic agent (anti-EGFR + chemotherapy 62.6% of patients; anti-VEGF + chemotherapy 18.4% of patients), whereas 19.0% received chemotherapy alone [ 27 ]. A biologic agent was received by 61.9% of patients with mutated RAS tumors [ 27 ]. In addition to intercountry variation, Kafatos and colleagues’ study reflects prescribing decisions made in 2018, several years after our RWD-ACROSS study was conducted.…”

“…Subsequent to 2017 when the aforementioned meta-analysis by Arnold and colleagues was published [ 20 ], the results of which were later confirmed by the PARADIGM study [ 19 ], patients with a wild-type RAS mCRC tumor have generally been treated with a combination of chemotherapy and an anti-EGFR agent. Analysis of the Kafatos et al study, which was conducted prior to the PARADIGM study, shows that the use of anti-EGFR treatment for this population group did not exceed 63% [ 27 ]. In our study 45% of patients with a primary tumor (in the left colon) that was wild-type for RAS received anti-EGFR combination therapy; this rate probably reflects our patient enrolment period (up to 2015), which was 1 year prior to publication of the Arnold et al meta-analysis and 7 years prior to the PARADIGM study.…”