Analyses of Multiple Factors for Determination of "Selected Patients" Who Should Receive Rechallenge Treatment in Metastatic Colorectal Cancer: a Retrospective Study from Turkey

Özaslan, Ersin; Ao, Duran; Bozkurt, Oktay; İnanç, Mevlüde; Uçar, Mahmut; Berk,; Karaca, Halıt; Elmalı, Ferhan; Özkan, Metin

doi:10.7314/apjcp.2015.16.7.2833

Cited by 7 publications

(4 citation statements)

References 39 publications

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“…We also estimated OS from the time of first dose of systemic therapy, instead of the time of randomization in clinical trials; those few weeks of gap time would have further contributed to the difference. On the other hand, our results agree with previous studies showing that the rechallenge of chemotherapy plus monoclonal antibodies can achieve substantial antitumor activity, particularly in patients with previous good response(s) to the regimens . Above all, the small sample size and retrospective nature of the study limited the robustness of our findings.…”

Section: Discussionsupporting

confidence: 89%

Real‐world treatment patterns and outcomes in refractory metastatic colorectal cancer

Chiang

Choi

Lam

et al. 2019

Asia-Pac J Clncl Oncology

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Aim To investigate treatment patterns and outcomes of metastatic colorectal cancer (mCRC) patients beyond second progression (PD2) since regorafenib and TAS‐102 became available in Hong Kong. Methods The clinical records of consecutive mCRC patients who were treated beyond PD2 at Department of Clinical Oncology, Queen Mary Hospital between June 2013 and February 2018, were retrospectively reviewed. Results Of 176 PD2 patients (76.7% Eastern Cooperative Oncology Group performance status 0/1 and a median follow‐up time of 6.6 [range, 0.4–37.2] months), 104 (59%) underwent palliative care only and 72 (41%) received active third‐line (3L) treatment: regorafenib (n = 22), TAS‐102 (n = 6), chemotherapy + antiepidermal growth factor receptor (n = 12), chemotherapy + antivascular endothelial growth factor (n = 28) or clinical trials (n = 4). Patients on active 3L treatment had significantly longer OS than those on palliative care only: 11.7 versus 5.5 months (adjusted hazard ratio = 0.41, 95% confidence interval: 0.28–0.61, P < 0.001). For those on active treatment, OS was significantly associated with the time from diagnosis of metastasis to PD2 (P < 0.001) and post‐3L treatments (P = 0.009). When analyzing treatment eligibility according to trial criteria, half of the eligible patients (54/109) did not receive active treatment, but both eligible and ineligible patients achieved better OS when receiving active 3L treatment versus palliative care only (P < 0.001 and P = 0.002). No unexpected toxicity was reported. Conclusion Active 3L and beyond treatment significantly prolonged OS versus palliative care, even in selected “trial ineligible” patients. Given a high rate of palliation only care in eligible patients, improved patient access to medicine and counseling may be needed to maximize outcomes.

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Section: Discussionsupporting

confidence: 89%

Real‐world treatment patterns and outcomes in refractory metastatic colorectal cancer

Chiang

Choi

Lam

et al. 2019

Asia-Pac J Clncl Oncology

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“…The similar results were reported in another chemotherapy rechallenge study from Turkey. 41 Undoubtedly, these above conclusions need to be further verified in larger studies.…”

Section: Discussionmentioning

confidence: 89%

Third-line treatment patterns and clinical outcomes for metastatic colorectal cancer: a retrospective real-world study

Deng,

Duan,

Bai

et al. 2023

Therapeutic Advances in Chronic Disease

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Background: There are multiple recommendations on the third-line therapy of metastatic colorectal cancer (mCRC); however, no consensus has been reached. Objectives: This study aimed to explore the patient demographics and the real-world third-line treatment landscape of mCRC. Design: A retrospective real-world cohort study. Methods: Electronic medical records of mCRC patients from Tianjin Medical University Cancer Institute and Hospital between 2013 and 2020 were collected. Upon descriptive, comparative, and survival analyses, a retrospective study was conducted to describe demographics and clinical outcomes of mCRC patients receiving third-line treatment. Results: Among 218 mCRC patients receiving third-line therapy, 65.5% received chemotherapy combined with or without targeted drugs, followed by anti-angiogenic monotherapy (18.4%), anti-epidermal growth factor receptor drugs (6.9%) and immunotherapy (6.4%). The overall response rate and disease control rate reached 10.2% and 59.2%, respectively; and median progression-free survival (PFS) and overall survival were 4.0 m and 10.7 m, respectively. After Cox multivariate analysis, we found that therapeutic regime was an independent prognostic factor. Compared to patients receiving anti-angiogenic monotherapy, those receiving chemotherapy combined with or without targeted drugs exhibited better prognosis. For patients whose PFS were longer in the front-line treatment, the PFS of third-line therapy was also relatively longer ( p = 0.023). Multiple types of therapies (>3, p = 0.002) or multiple drugs (>5, p = 0.024) in the whole-course management of mCRC are indicators of longer survival. Conclusion: Chemotherapy combined with or without targeted therapy remained dominated third-line choice and showed favorable efficacy compared with anti-angiogenic monotherapy. With the application of more types and quantities of effective drugs, patients would achieve better survival.

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“…Several reports on readministering anticancer drugs [8][9][10][11][12][13][14][15][16] have suggested that after a washout period, earlier-line drugs that were initially effective but then became ineffective might become effective again [11][12][13][14][15]. Santini et al reported cetuximab rechallenge to be significantly effective after a cetuximab-free interval with cytotoxic chemotherapy [13].…”

Section: Discussionmentioning

confidence: 99%

Readministration of Cancer Drugs in a Patient with Chemorefractory Metastatic Colorectal Cancer

Kawagoe

Ikeda

Oshiro

et al. 2020

Case Reports in Oncological Medicine

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A 63-year-old woman was admitted to our institution for severe pain in her right lower abdomen caused by the perforation of cecal cancer. She underwent emergency surgery, from which she was diagnosed with cecal carcinoma with liver, lung, and lymph node metastases. As she was taking aspirin to prevent cerebral infarction, anti-vascular endothelial growth factor (receptor) antibody and regorafenib therapy were not used. Thus, we started a modified FOLFOX 6+cetuximab regimen. This first-line treatment initially achieved a partial response (PR), but she then developed progressive disease (PD) after 14 months. We changed the regimen to FOLFIRI, followed by trifluridine/tipiracil, but her progression-free survival periods were 2.7 months and 1 month, respectively. Although we cycled through the available array of standard cancer drugs, the patient showed a good performance status, and some benefit from treatment still seemed plausible. We readministered the 5-fluorouracil oral preparation S-1, which maintained stable disease (SD) for 7 months. After PD emerged, we readministered the anti-epidermal growth factor receptor (EGFR) antibody panitumumab for 7.5 months of SD. Finally, 39 months after her diagnosis, she died from rapidly progressing disease. However, her relatively long survival implies that readministering drugs similar to those used in previous regimens might benefit patients with metastatic colorectal cancer.

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Analyses of Multiple Factors for Determination of "Selected Patients" Who Should Receive Rechallenge Treatment in Metastatic Colorectal Cancer: a Retrospective Study from Turkey

Cited by 7 publications

References 39 publications

Real‐world treatment patterns and outcomes in refractory metastatic colorectal cancer

Real‐world treatment patterns and outcomes in refractory metastatic colorectal cancer

Third-line treatment patterns and clinical outcomes for metastatic colorectal cancer: a retrospective real-world study

Readministration of Cancer Drugs in a Patient with Chemorefractory Metastatic Colorectal Cancer

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