Double or nothing? Choice of first-line chemotherapy in a real world metastatic colorectal cancer cohort results from the TRACC registry
Author(s)
Dunn, Catherine
Tie, Jeanne
Wong, Rachel
Kosimider, Suzanne
Field, Kathryn
Burge, Matthew
To, Yat Hang
Shapiro, Jeremy
Hong, Wei
Jennens, Ross
Parente, Phillip
Caird, Susan
Lee, Margaret
Lee, Belinda
et al.
Griffith University Author(s)
Year published
2021
Metadata
Show full item recordAbstract
Background: Fluoropyrimidine doublets are the instinctive choice for most Australian oncologists treating first-line metastatic colorectal cancer (mCRC). Accepted alternatives, supported by multiple randomised studies, include single-agent fluoropyrimidine (FP), which is associated with a similar overall survival (OS) when compared with doublets. Whilst combination therapies are associated with greater treatment response, intensifying treatment from single, to doublet and triplet chemotherapy is associated with increased toxicity.
Methods: Data were analysed from TRACC, a large multisite Australian cancer registry collecting ...
View more >Background: Fluoropyrimidine doublets are the instinctive choice for most Australian oncologists treating first-line metastatic colorectal cancer (mCRC). Accepted alternatives, supported by multiple randomised studies, include single-agent fluoropyrimidine (FP), which is associated with a similar overall survival (OS) when compared with doublets. Whilst combination therapies are associated with greater treatment response, intensifying treatment from single, to doublet and triplet chemotherapy is associated with increased toxicity. Methods: Data were analysed from TRACC, a large multisite Australian cancer registry collecting prospective demographic, tumour, treatment and outcome data for mCRC. We identified patients <75 years treated with first-line chemotherapy between 2009 and 2020, and determined the proportion treated with single-agent FP, doublet or triplet chemotherapy (with or without a biologic). Log-rank testing and Kaplan Meier curves were used to compare PFS and OS for FP versus doublet cohorts. Results: Of 2196 patients in TRACC, 1402 (63.8%) met study criteria. The majority received doublets (1237, 88.3%), with fewer receiving single-agent FP (145 = 10.3%) or triplet regimens (20 = 1.4%). Use of triplet (FOLFOXIRI) increased over time, with 9% receiving triplet therapy by 2020. Those receiving FP alone were older than those receiving doublet (median age 66 v 60 years), had a poorer performance status (ECOG 0%–1 74% v 93%) and greater comorbidity (Charlson comorbidity index > 3 in 59% v 30%). Patients receiving initial FP had inferior PFS compared with doublets (mPFS 7.5 v 10.8 months [HR 1.45, p < 0.0001]), but there was no difference in OS (mOS 24.8 v 27.4 months [HR 1.2, p = 0.1]). Conclusions: Doublet regimens are the dominant paradigm in mCRC in the first-line setting, despite the lack of OS advantage demonstrated in randomised clinical trials. Our local registry data supports this, despite prognostic factors biasing against FP alone. Use of triplet therapy, where an OS advantage has been demonstrated, is increasing.
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View more >Background: Fluoropyrimidine doublets are the instinctive choice for most Australian oncologists treating first-line metastatic colorectal cancer (mCRC). Accepted alternatives, supported by multiple randomised studies, include single-agent fluoropyrimidine (FP), which is associated with a similar overall survival (OS) when compared with doublets. Whilst combination therapies are associated with greater treatment response, intensifying treatment from single, to doublet and triplet chemotherapy is associated with increased toxicity. Methods: Data were analysed from TRACC, a large multisite Australian cancer registry collecting prospective demographic, tumour, treatment and outcome data for mCRC. We identified patients <75 years treated with first-line chemotherapy between 2009 and 2020, and determined the proportion treated with single-agent FP, doublet or triplet chemotherapy (with or without a biologic). Log-rank testing and Kaplan Meier curves were used to compare PFS and OS for FP versus doublet cohorts. Results: Of 2196 patients in TRACC, 1402 (63.8%) met study criteria. The majority received doublets (1237, 88.3%), with fewer receiving single-agent FP (145 = 10.3%) or triplet regimens (20 = 1.4%). Use of triplet (FOLFOXIRI) increased over time, with 9% receiving triplet therapy by 2020. Those receiving FP alone were older than those receiving doublet (median age 66 v 60 years), had a poorer performance status (ECOG 0%–1 74% v 93%) and greater comorbidity (Charlson comorbidity index > 3 in 59% v 30%). Patients receiving initial FP had inferior PFS compared with doublets (mPFS 7.5 v 10.8 months [HR 1.45, p < 0.0001]), but there was no difference in OS (mOS 24.8 v 27.4 months [HR 1.2, p = 0.1]). Conclusions: Doublet regimens are the dominant paradigm in mCRC in the first-line setting, despite the lack of OS advantage demonstrated in randomised clinical trials. Our local registry data supports this, despite prognostic factors biasing against FP alone. Use of triplet therapy, where an OS advantage has been demonstrated, is increasing.
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Conference Title
Asia-Pacific Journal of Clinical Oncology
Volume
17
Issue
S4
Publisher URI
Subject
Oncology and carcinogenesis
Science & Technology
Life Sciences & Biomedicine