MICRO ABSTRACTThis retrospective observational study assessed real-world treatment patterns and clinical outcomes among first-line MSI-H/dMMR metastatic colorectal cancer patients. Of 150 patients in the study cohort, 38.7% were treated with chemotherapy and 61.3% with chemotherapy + EGFR/VEGF inhibitor (EGFRi/VEGFi). Clinical outcomes were better among patients who received chemotherapy + EGFR/VEGF inhibitor than those who received chemotherapy.INTRODUCTIONPrior to pembrolizumab approval in first-line (1L) treatment of MSI-H/dMMR metastatic colorectal cancer (mCRC), patients were managed with chemotherapy with or without an EGFRi or VEGFi, agnostic of biomarker testing or mutation status. This study assessed real-world treatment patterns and clinical outcomes among 1L MSI-H/dMMR mCRC patients treated with standard of care (SOC).PATIENTS AND METHODSRetrospective observational evaluation of patients ≥18 years diagnosed with stage IV MSI-H/dMMR mCRC who received community-based oncology care. Eligible patients were identified (01-Jun-2017 - 29-Feb-2020) and followed longitudinally until 31-Aug-2020/the last patient record/date of death. Descriptive statistics and Kaplan-Meier analyses were conducted.RESULTSOf 150 1L MSI-H/dMMR mCRC patients, 38.7% were treated with chemotherapy and 61.3% with chemotherapy + EGFRi/VEGFi. Accounting for censoring, the overall median real-world time to treatment discontinuation (95% CI) was 5.3 (4.4, 5.8) months; 3.0 (2.1, 4.4) and 6.2 (5.5, 7.6) months in the chemotherapy and chemotherapy + EGFRi/VEGFi cohorts, respectively. The combined median overall survival was 27.7 (23.2, not reached [NR]) months; 25.3 (14.5, NR) and 29.8 (23.2, NR) months in the chemotherapy and chemotherapy + EGFRi/VEGFi cohorts, respectively. The overall median real-world progression-free survival was 6.8 (5.3, 7.8) months; 4.2 (2.8, 6.1) and 7.7 (6.1, 10.2) months in the chemotherapy and chemotherapy + EGFRi/VEGFi cohorts, respectively.CONCLUSIONS1L MSI-H/dMMR mCRC patients receiving chemotherapy with EGFRi/VEGFi had better outcomes than those receiving only chemotherapy. An unmet need and opportunity to improve outcomes exists in this population that may be addressed by newer treatments like immunotherapies.

2019-03-01·Strahlentherapie und Onkologie2区 · 医学

Combination of stereotactic radiotherapy and targeted therapy: patterns-of-care survey in German-speaking countries

2区 · 医学

Article

作者: Fritz, C ; Grosu, A L ; Basler, L ; Kroeze, S G C ; Brunner, T B ; Gkika, E ; Guckenberger, M

INTRODUCTIONStereotactic body radiotherapy (SBRT) is increasingly used in metastasized patients receiving targeted/immunotherapy. Information on safety and effectivity of concurrent SBRT and targeted/immunotherapy remains limited, resulting in a lack of consensus on treatment strategies. This study aimed to investigate how SBRT-experienced centers in German-speaking countries combine both therapies.MATERIALS AND METHODSPatterns-of-care of combined treatment with SBRT and targeted/immunotherapy were assessed in 27 radiation oncology centers (19 German, 1 Austrian and 7 Swiss centers). A survey was performed to analyze the details of SBRT, SBRT planning and combined modality treatment. Consensus was defined as ≥75% agreement among participants.RESULTSMost participants (60%) were university centers. SBRT for oligometastases has been performed since the year 2008 (median, range 1997-2016), since then a median of 140 cases (5-1100) of SBRT have been performed. In all, 67% performed concurrent SBRT and targeted agents. BRAF inhibitors and VEGF/EGFR inhibitors (bevacizumab [90%], erlotinib [11%], sorafenib [19%], lapatinib [4%]) were considered a contraindication. Bevacizumab was never given simultaneously with SBRT; other agents were given concurrently in 7-52% of centers. A majority (59%) paused targeted agents 1 week before/after SBRT. Only 1 center reduced SBRT dose when combined with targeted agents.CONCLUSIONAlthough evidence for safety and efficacy of concurrent SBRT and targeted agents is limited, it is regularly performed outside of clinical trials. The survey showed consensus not to combine SBRT with antiangiogenic agents, especially bevacizumab. Furthermore, SBRT with concurrent BRAF inhibitors should be practiced with caution and BRAF inhibitors should be paused at least 1 week before SBRT.

2017-09-12·Oncotarget

Targeted first-line therapies for advanced colorectal cancer: a Bayesian meta-analysis

Article

作者: Lopes, Gilberto ; Haaland, Benjamin ; Masud, Hasan ; Ku, Geoffrey ; Ridouane, Yassine

BACKGROUNDColorectal cancer is common and deadly. First-line treatments for patients with metastatic disease include FOLFIRI and FOLFOX, which have been combined with anti-EGFR or anti-VEGF antibodies to achieve benefit in selected populations. However, optimal therapy remains unclear.RESULTSFifteen publications on 10 trials were identified. There was a lack of decisive evidence that FOLFIRI or FOLFOX impact efficacy of either anti-EGFR or anti-VEGF, across mutational status groups. On the other hand, evidence suggests both anti-EGFR and anti-VEGF may be more effective for KRAS WT than MT patients. KRAS WT results provided evidence that anti-EGFR treatments may be more effective than anti-VEGF treatments when combined with FOLFIRI or FOLFOX. Further, evidence suggests that both anti-EGFR and anti-VEGF therapies, when combined with FOLFIRI or FOLFOX, may be harmful as compared to chemotherapy for KRAS MT patients.MATERIALS AND METHODSLiterature was searched for randomized trials comparing anti-EGFR or anti-VEGF antibodies, paired with FOLFIRI or FOLFOX, as first-line therapy for advanced colorectal cancer. Meta-estimates were generated via Bayesian hierarchical log-linear model. The primary endpoint was overall survival.CONCLUSIONSFurther studies examining impact of all-RAS mutation status, left or right side location of primary tumor, and combination anti-VEGF with modern bolus fluoropyrimidine are needed.

100 项与 DMS-3008 相关的药物交易

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