Factors That Influence Conversion to Resectability and Survival After Resection of Metastases in RAS WT Metastatic Colorectal Cancer (mCRC): Analysis of FIRE-3-AIOKRK0306

Autor: Dominik Paul Modest, Ingrid Ricard, Christiane Bruns, Jobst C. von Einem, Arndt Stahler, Daniel Seehofer, Timm Denecke, Kathrin Heinrich, Gunnar Folprecht, Johann Pratschke, Volker Heinemann, Marc H.A. Bemelmans, Thomas Becker, Ulf P. Neumann, Markus Rentsch, Hauke Lang, Swantje Held, Sebastian Stintzing, Bernhard Gebauer
Přispěvatelé: Surgery, MUMC+: MA Heelkunde (9), RS: FHML non-thematic output
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Oncology
Male
Colorectal cancer
Leucovorin
Cetuximab
0302 clinical medicine
Antineoplastic Combined Chemotherapy Protocols
metastatic colorectal cancer
Middle Aged
CHEMOTHERAPY
Survival Rate
Treatment Outcome
Hepatobiliary Tumors
030220 oncology & carcinogenesis
FOLFIRI
030211 gastroenterology & hepatology
Female
Fluorouracil
Colorectal Neoplasms
600 Technik
Medizin
angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
medicine.drug
medicine.medical_specialty
Randomization
Bevacizumab
BEVACIZUMAB
open-label
LIVER METASTASES
03 medical and health sciences
folfiri plus cetuximab
Internal medicine
medicine
Humans
Aged
Retrospective Studies
therapy
business.industry
Proportional hazards model
subgroup
kras
Odds ratio
Nomogram
medicine.disease
RANDOMIZED-TRIALS
1ST-LINE TREATMENT
ras Proteins
Surgery
Camptothecin
business
Zdroj: Annals of Surgical Oncology
Annals of Surgical Oncology, 27(7), 2389-2401. Springer, Cham
ISSN: 1068-9265
DOI: 10.1245/s10434-020-08219-w
Popis: Background Tumor assessments after first-line therapy of RAS wild-type mCRC with cetuximab (cet) versus bevacizumab (bev) in combination with FOLFIRI were evaluated for factors influencing resectability, conversion to resectability, and survival after best response. Methods Conversion to resectability was defined as conversion of initially unresectable to resectable disease at best response as determined by retrospective assessment. Univariate and multivariate logistic models were fitted with resectability at best response as response variable. A Cox model comparing the survival from best response was used to measure the influence of treatment, resectability at best response, and resection. Interaction of resection and treatment arm on survival was tested by likelihood ratio test. Results Overall, 270 patients were evaluable (127 cet-arm, 143 bev-arm). Lung metastases (odds ratio [OR] 0.35, 95% confidence response [CI] 0.19–0.63), BRAF mutation (OR 0.33, 95% CI 0.12–0.82), and elevated alkaline phosphatase (OR 0.42, 95% CI 0.18–0.9) before randomization were associated with less chance of successful conversion and were integrated into a nomogram. Early tumor shrinkage (OR 1.86, 95% CI 1.06–3.3; p 0.034) and depth of response (OR 1.02, 95% CI 1.01–1.03; p p = 0.039), predominantely in cet-treated patients (interaction test, p = 0.02). Conclusions Conversion to resectability is significantly associated with baseline characteristics that can be used in a nomogram to predict conversion. Moreover, early efficacy parameters (ETS and DpR) are associated with successful conversion therapy. In FIRE-3, resection of metastases was associated with improved post-best response survival, this effect originated predominantly from the cetuximab-based study arm.
Databáze: OpenAIRE
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