Treatment breaks in first line treatment of advanced colorectal cancer: An individual patient data meta-analysis
| Autor: | Kaitlyn K.H. Goey, Harpreet Wasan, Aimery de Gramont, Benoist Chibaudel, Tim Maughan, Axel Hinke, Roberto Labianca, Cornelis J A Punt, Kjell Magne Tveit, Susanna Hegewisch-Becker, Louise J. Brown, David E. Fisher, Richard Kaplan, Richard Adams, Eduardo Diaz Rubio, Dirk Arnold, Miriam Koopman |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Oncology medicine.medical_specialty Colorectal cancer medicine.medical_treatment Active monitoring Drug Administration Schedule Maintenance Chemotherapy 03 medical and health sciences 0302 clinical medicine Clinical Trials Phase II as Topic Maintenance therapy Quality of life Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Chemotherapy Radiology Nuclear Medicine and imaging Randomized Controlled Trials as Topic Thrombocytosis business.industry General Medicine Evidence-based medicine Treatment breaks Intermittent therapy medicine.disease Prognosis Oxaliplatin 030104 developmental biology Clinical Trials Phase III as Topic 030220 oncology & carcinogenesis Meta-analysis business Colorectal Neoplasms medicine.drug |
| Zdroj: | Cancer treatment reviews. 99 |
| ISSN: | 0305-7372 |
| Popis: | Background\ud Intermittent systemic anti-cancer therapy in patients with advanced colorectal cancer (aCRC) may improve quality of life without compromising overall survival (OS). We aimed to use individual patient data meta-analysis (IPDMA) from multiple randomised controlled trials evaluating intermittent strategies to inform clinical practice. We also aimed to validate whether thrombocytosis as a predictive biomarker identified patients with significantly reduced OS receiving a complete treatment break.\ud Patients and Methods\ud An IPDMA of intermittent strategy impact on survival was undertaken, including all relevant trials in which data were available. Intermittent strategies were classified into two groups: a planned stopping of all therapy (“treatment break strategy”; 6 trials; 2,907 patients) or to the same treatment omitting oxaliplatin (“maintenance strategy”; 3 trials; 1,271 patients). The primary analysis sample was of patients successfully completing induction therapy. Additionally, a pre-planned analysis of the predictive value of thrombocytosis on survival under a continuous versus an intermittent strategy was undertaken.\ud Results\ud All trials had comparable inclusion criteria. The overall IPDMA of intermittent therapy versus continuous therapy demonstrated no detriment in OS (HR=1.03 [95% CI 0.93-1.14]), whether from complete break (HR 1.04 [95% CI 0.87-1.26]) or maintenance strategies (HR 0.99 [95% CI 0.87-1.13]). Thrombocytosis was confirmed as a marker of poor prognosis in aCRC, but did not predict for OS detriment from treatment break strategies (interaction HR=0.97 [95% CI 0.66-1.40] compared to continuous therapy).\ud Conclusion\ud The highest levels of evidence from this IPMDA indicate no detriment in survival for patients receiving an intermittent therapy strategy, either for maintenance or complete break strategies. Although, thrombocytosis is confirmed as a marker of poor prognosis, it is not predictive of poor outcome for patients treated with intermittent therapy. An intermittent chemotherapy strategy can therefore be applied irrespective of baseline platelet count and does not result in inferior OS compared to continuous chemotherapy. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect