Chemotherapy and biologic use in the routine management of metastatic colorectal cancer in Australia: is clinical practice following the evidence?
Publication Year 2019-08, Volume 49, Issue #4, Page 446-454
Journal Title
Internal Medicine Journal
Publication Type
Journal Article
BACKGROUND: Emerging evidence on the optimal use of chemotherapy and biologics in patients with metastatic colorectal cancer (mCRC) should impact management in routine care. Recent studies have demonstrated benefits for initial triplet chemotherapy (FOLFOXIRI) and for initial treatment with an epidermal growth factor receptor inhibitor (EGFRi) in patients with a RAS wild type tumour and a left-sided primary. AIM: To explore evolving patterns of mCRC care over time in Australia. METHODS: We analysed data from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry. RESULTS: From July 2009 to December 2017, 2552 mCRC patients were entered into the TRACC registry. Of 1585 patients who initially underwent chemotherapy, treatment was with a doublet in 76%. FOLFOXIRI was given to 22 patients (1.4%), mostly young patients and those with potentially resectable disease. Along with first-line chemotherapy, 61% received bevacizumab, while 3.3% received an EGFRi, predominantly over the last two years. Within the KRAS wild-type left-sided tumour cohort, EGFRi use increased from 9% in 2015 to 37% in 2017. Across treatment sites, there was wide variation in the utilization of FOLFOXIRI and EGFRi therapy; bevacizumab use was more consistent. A clear impact on survival outcomes from these regimens is not evident, potentially due to multiple confounders. CONCLUSION: Doublet chemotherapy plus bevacizumab remains the dominant initial strategy, with limited uptake of triplet chemotherapy and of EGFRi. Potential explanations include uncertainty about the significance of post-hoc analyses for EGFRi and concerns regarding adverse events for both strategies. This article is protected by copyright. All rights reserved.
WEHI Research Division(s)
Systems Biology And Personalised Medicine
PubMed ID
Publisher's Version
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Creation Date: 2018-09-21 02:32:26
Last Modified: 2020-11-03 11:14:09
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