Safety and Efficacy of Radioembolization in Elderly (≥ 70 Years) and Younger Patients With Unresectable Liver-Dominant Colorectal Cancer

Kennedy, Andrew S.; Ball, David S.; Cohen, Steven J.; Cohn, Michael; Coldwell, Douglas M.; Drooz, Alain; Ehrenwald, Eduardo; Kanani, Samir; Rose, Steven C.; Nutting, Charles; Moeslein, Fred; Savin, Michael A.; Schirm, Sabine; Putnam, Samuel; Sharma, Navesh K.; Wang, Eric A.

doi:10.1016/j.clcc.2015.09.001

Cited by 21 publications

(24 citation statements)

References 38 publications

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“…Consistent with a previous report, we found no significant difference in survival outcomes between elderly patients ≥70 years and those younger ( Table 2). This confirms our earlier conclusion that 90 Y-RE is a safe and effective treatment for elderly patients with unresectable colorectal cancer liver metastases, and that age should not be a criteria for exclusion from this treatment (12). 90 Y-RE has traditionally been administered as treatment for metastatic colorectal cancer liver metastases after failure of chemotherapies and other systemic therapies to control the disease (4-6).…”

Section: Discussionsupporting

confidence: 75%

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Kennedy

Cohn

Coldwell

et al. 2017

J. Gastrointest. Oncol.

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Background: The Metastatic colorectal cancer liver metastases Outcomes after RadioEmbolization (MORE) study was a retrospective analysis of 606 patients with unresectable colorectal liver metastases treated with radioembolization (RE) using 90 Y-labeled resin microspheres. The first analysis of this study was completed with a last patient follow-up of 77.7 months. We now provide an updated survival analysis through September 15, 2016, with a last patient follow-up of 125 months. Methods: 90 Y-RE was considered for patients with advanced liver-only or liver-dominant metastatic colorectal cancer which was deemed not suitable for surgery, ablation, or systemic therapy, and which had progressed or become refractory to at least one line of systemic therapy. All patients with a diagnosis of metastatic colorectal cancer who had received at least 1 RE treatment and 1 follow-up visit were included in the analysis. Patients were treated between July 2002 and December 2011 at one of 11 U.S. tertiary care centers. Data were collected at baseline, on the day of the first 90 Y-RE treatment (day 0), and at all subsequent visits or until death. Patient medical charts and/or public records were accessed to obtain dates of death. Results: Dates of death were obtained for 574 out of a total of 606 patients, and overall survival (OS) data analyzed. Updated median OS was 10.0 months (95% CI: 9.2-11.8 months) at a median follow-up of 9.5 months versus the originally reported median OS of 9.6 months (95% CI: 9.0-11.1 months) at a follow-up of 8.6 months in the first MORE analysis. Patients received a median (range) of 2 (0 to 6) lines of chemotherapy. Baseline characteristics and factors significantly associated with patient survival (P<0.01) are consistent with those reported in the first safety analysis of the MORE study. These factors include poor ECOG performance status, markers of advanced disease such as increased extent of tumor-to-target liver involvement, poor baseline liver function, pre-treatment anemia, lung shunt fraction, and number of lines of prior chemotherapy. Patient age did not significantly affect survival outcomes. Conclusions: Long-term follow-up confirms that 90 Y-RE treatment offers favorable survival benefits for patients with unresectable metastatic colorectal cancer, even among patients who received 3 or more prior lines of chemotherapy. Our analysis also supports earlier reported prognostic factors for survival after 90 Y-RE. Overall, our updated analysis confirms that 90 Y-RE treatment provided a meaningful response and survival advantage for MORE patients across all ages and across diverse community and academic centers in the U.S.

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Section: Discussionsupporting

confidence: 75%

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Kennedy

Cohn

Coldwell

et al. 2017

J. Gastrointest. Oncol.

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“…The fact that MORE was a retrospective analysis is the chief limitation of the study; however, all patients treated during the pre-specified period were included in all evaluations. Patients were also selected from specialist tertiary care centers and (previously shown in evaluation of the elderly versus the young), there was an inevitable selection bias at these centers towards younger and/or fitter patients; although, elderly and young patients were found to tolerate the treatment equally well (38).…”

Section: Anemia and Rementioning

confidence: 99%

Baseline hemoglobin and liver function predict tolerability and overall survival of patients receiving radioembolization for chemotherapy-refractory metastatic colorectal cancer

Kennedy

Ball

Cohen

et al. 2017

J. Gastrointest. Oncol.

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Background: Patients with liver metastatic colorectal cancer (mCRC) often benefit from receiving 90 Y-microsphere radioembolization (RE) administered via the hepatic arteries. Prior to delivery of liverdirected radiation, standard laboratory tests may assist in improving outcome by identifying correctable preradiation abnormalities. Methods: A database containing retrospective review of consecutively treated patients of mCRC from July 2002 to December 2011 at 11 US institutions was used. Data collected included background characteristics, prior chemotherapy, surgery/ablation, radiotherapy, vascular procedures, 90 Y treatment, subsequent adverse events and survival. Kaplan-Meier estimates compared the survival of patients across lines of chemotherapy. The following values were obtained within 10 days prior to each RE treatment:haemoglobin (HGB), albumin, alkaline phosphatase (Alk phosph), aspartate aminotransferase (AST), alanine transaminase (ALT), total bilirubin and creatinine. Common Terminology Criteria Adverse Events (CTCAEs) 3.0 grade was assigned to each parameter and analysed for impact on survival by line of chemotherapy. Consensus Guidelines were used to categorize the parameter grades as either within or outside guidelines for treatment.Results: A total of 606 patients (370 male; 236 female) were studied with a median follow-up was 8.5 mo.(IQR 4.3-15.6) after RE. Fewer than 11% of patients were treated outside recommended RE guidelines, with albumin being the most common, 10.5% grade 2 (<3-2.0 g/dL) at time of RE. All seven parameters showed statistically significant decreased median survivals with any grade >0 (P<0.001) across all lines of prior chemotherapy. Compared to grade 0, grade 2 albumin decreased overall survival 67%; for grade 2 total bilirubin a 63% drop occurred, and grade 1 HGB resulted in 66% lower median survival. Conclusions: Review of pre-RE laboratory parameters may aid in improving median survivals if correctable grade >0 values are addressed prior to radiation delivery. HGB <10 g/dL is a well-known negative factor in radiation response and is easily corrected. Improving other parameters is more challenging. These efforts are important in optimizing treatment response to liver radiotherapy. IntroductionColorectal cancer is the third most common can¬cer and the second most common cause of cancer death in developed countries (1). The mainstay for the management of metastatic colorectal cancer (mCRC) is chemotherapy ± biologic therapies (2). Drug and regimen advances in systemic therapy (3) have substantially improved median survivals over the last decades and provided a meaningful window for the localized control of liver metastases (a common presentation in mCRC patients), especially whenever the extrahepatic disease appears to have an indolent clinical course. Liver-directed approaches to therapy are used to treat: (I) discrete, visually-targeted tumors using resection, ablation, NanoKnife ® (U/S), irreversible electroporation (IRE), or stereotactic body radiation therapy (SBRT)...

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“…All of the studies were retrospective, of which 7 were population-based cohort studies [25,26,[40][41][42][43][44], 16 retrospective analyses of patient cohorts [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60], 4 case-control studies [61][62][63][64], and 2 propensity score matched (PSM) case-control studies [65,66]. Overall, 5 studies (17.8%) were multicentric [48,49,51,59,66]. The study time frames spanned from 1986 to 2017, with a mean of 9.64 years (range: 8 months-22 years).…”

Section: Plos Onementioning

confidence: 99%

Surgical and regional treatments for colorectal cancer metastases in older patients: A systematic review and meta-analysis

et al. 2020

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The present study explored the existing literature to describe the outcomes of surgical and regional treatments for colorectal cancer metastases (mCRC) in older patients. Methods A literature search was conducted in PubMed, EMBASE, Cochrane and ClinicalTrials.gov for studies published since 2000 that investigated the short-and long-term outcomes of regional treatments (surgical or non-surgical) for mCRC in patients aged �65 years. Pooled data analyses were conducted by calculating the risk ratio (RR), mean differences (MD) and hazard ratio (HR) between older and younger patients or between two different approaches in older patients. Results After screening 266 articles, 29 were included in this review. These studies reported the outcomes of surgery (n = 19) and non-surgical local ablation treatments (n = 3) for CRC metastases in older vs. younger patients or compared the outcomes of different interventions in

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Safety and Efficacy of Radioembolization in Elderly (≥ 70 Years) and Younger Patients With Unresectable Liver-Dominant Colorectal Cancer

Cited by 21 publications

References 38 publications

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Baseline hemoglobin and liver function predict tolerability and overall survival of patients receiving radioembolization for chemotherapy-refractory metastatic colorectal cancer

Surgical and regional treatments for colorectal cancer metastases in older patients: A systematic review and meta-analysis

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