Rate of patients receiving second-line treatment for metastatic colorectal cancer in a real-world setting

Abstract

Background: Colorectal cancer is the third most common cancer diagnosed in Australia. Although a large portion (46.4%) present at an early stage, up to 45% relapse and many others present with de novo metastatic disease.1, 2 Although the treatment landscape for metastatic colorectal cancer (mCRC) is rapidly evolving, little is known about real-world impact of various regimens or utilisation rates of treatments beyond first-line. Aims: To evaluate the real-world rates of mCRC patients receiving systemic therapy beyond first line at a regional cancer centre (Sunshine Coast Hospital and Health Service - SCHHS). As well as the regimen choice and relative rates of treatment progression of the different regimens utilised in the first line. Methods: A retrospective analysis of all patients with mCRC who received first-line palliative systemic chemotherapy between January 2014 and December 2020 at SCHHS has been conducted. Real-world treatment patterns including rates of progression and survival were also examined. Results: During this time period, 249 patients diagnosed with mCRC received first-line treatment at our centre. Of these patients, 136 (54.6%) patients progressed to second-line treatment. Progression rates dropped through treatment lines, with 18.9% and 5.2% of patients receiving 3rdand 4thline treatments respectively. Doublet therapy with or without a biological agent was the most commonly used first-line treatment option with 199 patients (79.9%). Conclusion: Overall 54.6% of mCRC patients at our centre progressed onto second-line treatment therapy, which is higher than the current literature with studies reporting rates of 48.9% and 52.2%.3, 4 These results show that at our centre, although percentages are lower than initially perceived, they are higher than other international statistics. Welfare AIoHa. Cancer in Australia 2019. Canberra: AIHW; 2019. Wilhelmsen M, Kring T, Jorgensen LN, Madsen MR, Jess P, Bulut O, et al. Determinants of recurrence after intended curative resection for colorectal cancer. Scand J Gastroenterol. 2014;49(12):1399-408. Hess LM, Cui ZL, Mytelka DS, Han Y, Goodloe R, Schelman W. Treatment patterns and survival outcomes for patients receiving second-line treatment for metastatic colorectal cancer in the USA. Int J Colorectal Dis. 2019;34(4):581-8. Jeremy Snider EWSAJSGSWCRFVS, Scott David R. Metastatic colorectal cancer (mCRC) treatment patterns in the Medicare population. Journal of Clinical Oncology. 2018;36(4):823.