A Systematic Review of Conversion to Resectability in Unresectable Metastatic Colorectal Cancer Chemotherapy Trials.

Autor:	Chrabaszcz S; Departments of Surgery., Rajeev R; Department of Surgery, Virginia Commonwealth University, Richmond, VA., Witmer HDD; Department of Surgery, University of Chicago, Chicago, IL., Dhiman A; Department of Surgery, University of Chicago, Chicago, IL., Klooster B; Department of Surgery, University of Chicago, Chicago, IL., Gamblin TC; Departments of Surgery., Banerjee A; Biostatistics, Medical College of Wisconsin, Milwaukee, WI., Johnston FM; Department of Surgery, Johns Hopkins University, Baltimore, MD., Turaga KK; Department of Surgery, University of Chicago, Chicago, IL.
Jazyk:	angličtina
Zdroj:	American journal of clinical oncology [Am J Clin Oncol] 2022 Aug 01; Vol. 45 (8), pp. 366-372. Date of Electronic Publication: 2022 Jul 15.
DOI:	10.1097/COC.0000000000000921
Abstrakt:	Objectives: Metastasectomy in patients with metastatic colorectal cancer (mCRC) confers a significant survival benefit. We hypothesized that conversion to resectability (C2R) correlates with superior overall survival (OS) in patients with unresectable mCRC. Methods: A prospectively registered systematic review (PROSPERO CRD42015024104) of randomized clinical trials published after 2003 was conducted. Exposure of interest was C2R with a primary outcome of OS. Clinical trials were classified based on difference in C2R between study arms (<2%, 2% to 2.9%, ≥3%). Generalized estimating equations were used to measure associations while adjusting for multiple observations from the same trial. Results: Of 2902 studies reviewed, 30 satisfied selection criteria (n=13,618 patients). Median C2R was 7.3% (interquartile range [IQR]: 5% to 12.9%), with maximum C2R in the FOLFOX/FOLFIRI+cetuximab arm (28.6%). The median difference in C2R between 2 arms of the same study was 2.3% (IQR: 1.3% to 3.4%) with a maximum difference of 15.4% seen in FOLFOX/FOLFIRI+cetuximab versus FOLFOX/FOLFIRI. Median OS for the entire patient cohort was 20.7 months (IQR: 18.9 to 22.7 mo), with a between group difference of 1.3 months (IQR: -1.2 to 3.6 mo). The median survival difference between the 2 study arms with <2% C2R difference was 0.8 months versus 1.6 months with ≥3% C2R rates . Increasing C2R had an incremental dose-effect response on OS ( P =0.021), and higher response rates correlated with C2R rates ( P =0.003). Conclusions: C2R occurs infrequently and variably in clinical trials enrolling patients with unresectable mCRC. Prioritization of chemotherapeutic agents that enhance C2R might improve OS of patients. Competing Interests: K.K.T. speaks for Aspire Bariatrics. The remaining authors declare no conflicts of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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