Eastern Canadian Colorectal Cancer Consensus Conference 2017

McGee, Sharon F.; Alghareeb, Waleed; Ahmad, CM; Armstrong, Dawn Elizabeth; Babak, Sam; Berry, Scott; Biagi, Jim; Booth, Christopher M.; Bossé, Dominick; Champion, P.; Colwell, Bruce; Finn, Nicholas; Goel, Ritika; Gray, Samantha; Green, J.; Harb, Mohammed; Hyde, Angela J.; Jeyakumar, Alwin; Jonker, Derek J.; Kanagaratnam, Sivaruban; Kavan, Petr; MacMillan, Andrée; Muinuddin, Ahmad; Patil, Nikhilesh; Porter, Geoffrey A.; Powell, Erin; Ramjeesingh, Ravi; Raza, Muhammad; Rorke, Stewart; Seal, Melanie; Servidio-Italiano, Filomena; Siddiqui, J.; Simms, J. M.; Smithson, Lauren; Snow, Stephanie; St‐Hilaire, Ève; Stuckless, Teri; Tate, Angela J.; Tehfé, Mustapha; Thirlwell, Michael P.; Цветкова, Е. В.; Valdés, M.; Vickers, Michael M.; Virik, Kiran; Welch, Sarah; Marginean, Celia; Asmis, Timothy R.

doi:10.3747/co.25.4083

Cited by 5 publications

(2 citation statements)

References 108 publications

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“…Extended RAS mutation status was captured for 98.6% of the patients, with 60.0% of the patients overall (n = 430) being classified as RAS mutant; 38.6% (n = 277), as RAS wild-type; and 1.4% (n = 10), as RAS status unknown. The high rate of RAS mutation testing is clinically meaningful and conforms to the recommendations published by expert Canadian groups [29][30][31] .…”

Section: Patient and Disease Characteristicssupporting

confidence: 68%

Real-World Use of Trifluridine/Tipiracil for Patients with Metastatic Colorectal Cancer in Canada

Samawi

Afzal²,

Cheung³

et al. 2019

Current Oncology

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Background Outcomes for patients with metastatic colorectal cancer (mcrc) are improving with the introduction of new treatments. Treatment for patients who are still fit after failure of all available therapies represents a significant unmet need. In the present study, we analyzed real-world treatment patterns for patients enrolled in Health Canada’s trifluridine/tipiracil (ftd/tpi) Special Access Program (sap) and Taiho Pharma Canada’s Patient Support Program (psp).Methods Demographic information and clinical treatment data were collected from adults with mcrc who were previously treated with, or were not candidates for, available therapies and who were enrolled in the sap and psp. For all patients, ftd/tpi treatment status, discontinuation reasons, and prior therapies were examined.Results The analysis included 717 Canadian patients enrolled in the ftd/tpi sap and psp from September 2017 to October 2018. In that cohort, 59.7% were men, median age was 65 years, and median duration of therapy was 77 days (25%–75% interquartile range: 43–106 days). Of treated patients, 67.1% maintained the same dose for the duration of therapy; 28.0% had a dose reduction. On multivariable analysis, duration of therapy was not influenced by sex, age, province, RAS mutation status, or prior therapies. However, prior oxaliplatin-based chemotherapy (capox or folfox) appeared to be associated with higher rates of discontinuation because of death or disease progression.Conclusions In advanced mcrc, ftd/tpi is a well-tolerated therapy. The large number of patients enrolled in the access programs within a short period of time is reflective of major clinical need in this area, with many patients being eligible and interested in pursuing treatment in the refractory setting.

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Section: Patient and Disease Characteristicssupporting

confidence: 68%

Real-World Use of Trifluridine/Tipiracil for Patients with Metastatic Colorectal Cancer in Canada

Samawi

Afzal²,

Cheung³

et al. 2019

Current Oncology

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“…Post hoc retrospective analysis of pivotal trials and several meta-analyses have demonstrated overall survival (OS) improvements with the addition of EGFR inhibitors to chemotherapy versus chemotherapy +/− bevacizumab in patients with 1L RAS wild-type (WT) left-sided mCRC [ 12 , 13 , 14 , 15 , 16 ]. As such, clinical and molecular markers including PTL should be taken into consideration to guide treatment decisions related to 1L mCRC, as recommended by clinical practice guidelines [ 17 , 18 ] and several Canadian consensus papers [ 19 , 20 , 21 , 22 , 23 ]. The randomized controlled phase 3 PARADIGM study prospectively demonstrated that panitumumab added to mFOLFOX6 led to a median OS benefit of 3.6 months in the left-sided population over bevacizumab plus mFOLFOX6 [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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

Boyne,

Ngan,

Carbonell

et al. 2023

Current Oncology

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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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Assessing neoadjuvant therapy recommendations in 19 national and international guidelines for rectal cancer

Mroczkowski,

Atay,

Viebahn

2024

Tech Coloproctol

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Background Treatment guidelines belong to the most authoritative sources of evidence-based medicine and are widely implemented by health-care providers. Rectal cancer with an annual incidence of over 730,000 new cases and nearly 340,000 deaths worldwide, remains a significant therapeutic challenge. The total mesorectal excision (TME) leads to a dramatic improvement of local control. The addition of neoadjuvant treatment has been proposed to offer further advancement. However, this addition results in significant functional impairment and a decline in the quality of life. Methods This review critically assesses whether the recommendation for neoadjuvant treatment in current international guidelines is substantiated. A comprehensive search was conducted in July 2022 in PubMed resulting in 988 papers published in English between 2012 and 2022. After exclusions and proofs 19 documents remained for further analysis. Results Of the 19 guidelines considered in this review, 11 do not recommend upfront surgery, and 12 do not address the issue of functional impairment following multimodal treatment. The recommendation for neoadjuvant therapy relies on outdated references, lacking differentiated strategies based on current utilisation of MRI staging; numerous guidelines recommend neoadjuvant treatment also to subgroups of patients, who may not need this therapy. Also statements regarding conflicts of interest are often not presented. Conclusions An immediate and imperative step is warranted to align the recommendations with the latest available evidence, thereby affording rectal cancer patients a commensurate standard of care. A meticulous assessment of the guideline formulation process has the potential to avert heterogeneity in the future.

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Eastern Canadian Colorectal Cancer Consensus Conference 2017

Cited by 5 publications

References 108 publications

Real-World Use of Trifluridine/Tipiracil for Patients with Metastatic Colorectal Cancer in Canada

Real-World Use of Trifluridine/Tipiracil for Patients with Metastatic Colorectal Cancer in Canada

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

Assessing neoadjuvant therapy recommendations in 19 national and international guidelines for rectal cancer

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