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

Abstract

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.

Outcomes of Patients with Metastatic Colorectal Cancer Treated with Trifluridine/Tipiracil beyond the Second Line: A Multicenter Retrospective Study from Saudi Arabia

“…Lastly, ethnic differences and the small number of enrolled patients may have impacted the results [ 16 , 17 ]. The current study supports other compassionate use programs of FTD/TPI worldwide, which have been conducted for refractory mCRC and have confirmed their efficacy in a real-world population [ 26 – 28 ]. Real-world data are very important and reflect the efficacy of drugs in clinical practice, but it has the limitation of being retrospective, in a less homogeneous population, and generated from uncontrolled trials with different methodologies, which could hamper the generalizability of the results [ 17 ].…”

Palliative Care in Colorectal Cancer

“…Chemotherapy administration near death, showed that this approach did not improve quality of life for patients with poor performance status, and can be detrimental also for patients with good performance status [13]. Third line and beyond treatments prolonged overall survival versus palliative care, in high selected [32].…”

Metastatic Colorectal Carcinoma after Second Progression and the Role of Trifluridine-Tipiracil (TAS-102) in Switzerland

“…Several compassionate use programs of FTD/TPI across Europe, the USA, and Asia have been conducted and in summary they underline the efficacy and safety of FTD/TPI in a real-world population with refractory mCRC [17][18][19][20][21].…”