The Predictive Effect of Primary Tumour Location in the Treatment of Metastatic Colorectal Cancer: A Canadian Consensus Statement

Abrahão, Ana Beatriz Kinupe; Karim, Safiya; Colwell, Bruce; Berry, Scott; Biagi, James

doi:10.3747/co.24.3757

Cited by 8 publications

(7 citation statements)

References 40 publications

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“…According to a Canadian consensus statement, FOLFOX/FOLFIRI (folinic acid, fluorouracil and oxaliplatin/irinotecan) + bevacizumab is standard of care for patients with RAS wildtype right-sided primary tumours [55]. In the Phase III CALGB 80405 trial, patients with right-sided primary tumours treated with first-line chemotherapy + bevacizumab demonstrated an ORR of 39.7% [56].…”

Section: Introductionmentioning

confidence: 99%

“…In the Phase III CALGB 80405 trial, patients with right-sided primary tumours treated with first-line chemotherapy + bevacizumab demonstrated an ORR of 39.7% [56]. The Canadian consensus recommends chemotherapy in combination with an anti-EGFR monoclonal antibody (cetuximab or panitumumab) in patients with RAS wildtype left-sided tumours [55]. In the CALGB 80405 trial, patients with left-sided primary tumours treated with first-line chemotherapy + anti-EGFR monoclonal antibody demonstrated an ORR of 69.4%.…”

Section: Introductionmentioning

confidence: 99%

“…In the Phase II KEYNOTE-164 trial, patients with CRC who had received ≥2 prior lines of therapy, were MSI-high/dMMR, and received pembrolizumab had an ORR of 33% [59]. For proficient MMR patients (pMMR), not eligible for second-line immunotherapy, the Canadian consensus recommends standard chemotherapy [55]. Bevacizumab would be included for any patients who did not receive it first-line [55].…”

Section: Introductionmentioning

confidence: 99%

“…For proficient MMR patients (pMMR), not eligible for second-line immunotherapy, the Canadian consensus recommends standard chemotherapy [55]. Bevacizumab would be included for any patients who did not receive it first-line [55].…”

Section: Introductionmentioning

confidence: 99%

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Women’s Views about Breast Cancer Prevention at Mammography Screening Units and Well Women’s Clinics

et al. 2020

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Background Women attending mammography screening units (msus) and well women’s clinics (wwcs) represent a motivated cohort likely to engage in interventions aimed at primary breast cancer (bca) prevention. Methods We used a feasibility questionnaire distributed to women (40–49 or 50–74 years of age) attending msus and wwcs in Halifax, Nova Scotia, to examine ■ women’s views about bca primary prevention and sources of health care information, ■ prevalence of lifestyle-related bca risk factors, and ■ predictors of prior mammography encounters within provincial screening guidelines. Variables examined included personal profiling, comorbidities, prior mammography uptake, lifestyle behaviours, socioeconomic status, health information sources, and willingness to discuss or implement lifestyle modifications, or endocrine therapy, or both. A logistic regression analysis examined associations with prior mammography encounters. Results Of the 244 responses obtained during 1.5 months from women aged 40–49 years (n = 75) and 50–74 years (n = 169), 56% and 75% respectively sought or would prefer to receive health information from within, as opposed to outside, health care. Lifestyle-related bca risk factors were prevalent, and most women were willing to discuss or implement lifestyle modifications (93%) or endocrine therapy (67%). Of the two age groups, 49% and 93% respectively had previously undergone mammography within guidelines. Increasing age and marital status (single, separated, or divorced vs. married or partnered) were independent predictors of prior mammography encounters within guidelines for women 40–49 years of age; no independent predictors were observed in the older age group. Conclusions Women attending msus and wwcs seem to largely adhere to mammography guidelines and appear motivated to engage in bca primary prevention strategies, including lifestyle modifications and endocrine therapy. Women’s views as observed in this study provide a rationale for the potential incorporation of bca risk assessment within the “mammogram point of care” to engage motivated women in bca primary prevention strategies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Women’s Views about Breast Cancer Prevention at Mammography Screening Units and Well Women’s Clinics

et al. 2020

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“…Recent guidelines from the U.S. National Comprehensive Cancer Network 9 also suggest that only patients with left-sided ptl should be offered an egfri-containing regimen as initial therapy, because "there is a preponderance of data to suggest lack of activity of cetuximab and panitumumab in initial therapy for patients whose primary tumours originated on the right side of the colon" 9 . In Canada, similar consensus recommendations based on ptl have also been made for first-line treatment 10 .…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Selective First-Line Use of Biologics for Unresectable RAS Wild-Type Left-Sided Metastatic Colorectal Cancer

et al. 2019

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Background Evidence from a retrospective analysis of multiple large phase iii trials suggested that primary tumour location (ptl) in RAS wild-type metastatic colorectal cancer (wtRAS mcrc) might have predictive value with respect to response to drug therapies. Recent studies also show a potential preferential benefit for epidermal growth factor inhibitors (egfris) for left-sided tumours. In the present study, we aimed to determine the incremental costeffectiveness ratio (icer) for the first-line use of an egfri for patients with left-sided wtRAS mcrc.Methods We developed a state-transition model to determine the cost effectiveness of alternative treatmentstrategies in patients with left-sided mcrc:■ Standard of care■ Use of an egfri in first-line therapyThe cohort for the study consisted of patients diagnosed with unresectable wtRAS mcrc with an indication for chemotherapy and previously documented ptl. Model parameters were obtained from the published literature and calibration. The perspective was that of a provincial ministry of health in Canada. We used a 5-year time horizon and an annual discount rate of 1.5%.Results Selecting patients for first-line egfri treatment based on left-sided location of their colorectal primary tumour was more effective than the standard of care, resulting in an increase in quality-adjusted life-years (qalys) of 0.226 (or 0.644 life-years gained). However, the strategy was also more expensive, costing an average of $60,639 more per patient treated. The resulting icer was $268,094 per qaly. A 35% price reduction in the cost of egfri would be needed to make this strategy cost-effective at a willingness-to-pay threshold (wtp) of $100,000 per qaly.Conclusions Selective use of an egfri based on ptl was more cost-effective than unselected use of those agents; however, based on traditional wtp thresholds, it was still not cost-effective. While awaiting the elucidation of more precise predictive biomarkers that might improve cost-effectiveness, the price of egfris could be reduced to meet the wtp threshold.

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Analysis of reporting quality of clinical practice guidelines/consensuses on metastatic colorectal cancer based on the RIGHT checklist

Liu

et al. 2022

Journal of Healthcare Quality Research

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The Predictive Effect of Primary Tumour Location in the Treatment of Metastatic Colorectal Cancer: A Canadian Consensus Statement

Cited by 8 publications

References 40 publications

Women’s Views about Breast Cancer Prevention at Mammography Screening Units and Well Women’s Clinics

Women’s Views about Breast Cancer Prevention at Mammography Screening Units and Well Women’s Clinics

Cost-Effectiveness Analysis of Selective First-Line Use of Biologics for Unresectable RAS Wild-Type Left-Sided Metastatic Colorectal Cancer

Analysis of reporting quality of clinical practice guidelines/consensuses on metastatic colorectal cancer based on the RIGHT checklist

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