P-285 - Treatment of metastatic colorectal cancer. Experience of Centro Javeriano de Oncología of Hospital Universitario San Ignacio, Bogotá, Colombia

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Colon Cancer
Rectal Cancer
Presenter A.V. Ospina Serrano
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors A.V. Ospina Serrano, A.K. Natera Melo, R. Bruges Maya, A. Ruiz Morales
  • Hospital Universitario San Ignacio, Bogotá/CO

Abstract

Introduction

Colorectal cancer is the third most frequently diagnosed cancer in Europe, corresponding to 13% and the second in mortality. In Colombia is the fifth leading cause of death by cancer, nevertheless, there is not a suitable local record of patient's characteristics nor the response to treatment with chemotherapy, targeted biological therapy and metastasectomy.

Methods

Is a descriptive and retrospective study that included 126 patients with metastatic colorectal cancer who were treated in “Centro Javeriano de Oncología del Hospital Universitario San Ignacio” between 2.008 and 2.011. Therapeutic, histopathological and demographic characteristics were collected. The analysis was performed using the software STATA 13, considering a significance level of 5%. Variable comparisons were realized with chi square test, Fisher exact and Kaplan-Meier curves for survival calculations.

Results

126 patients were included, 52% were classified as stage IV at diagnosis and the rest developed metastasis during follow-up. Average age was 59.7 years. The main metastasis sites were liver (68%), lung (35%) and peritoneum (20%). KRAS study was available in 53% of the patients, 69% expressed wild-type KRAS. 31% of patients with colon cancer were diagnosed during an urgent surgical procedure. In 73% of patients with rectal cancer who received neoadjuvant chemoradiation was possible surgical resection of the primary tumor.

102 patients were operated, 45% received adjuvant chemotherapy (17% stage II and 83% stage III). Average time of progression for patients who received adjuvant chemotherapy was 21.5 months in stage II and 22.9 months in stage III. 110 patients received palliative chemotherapy, 41% one line, 28% two lines, 20% three lines and 11% four lines. The most often used chemotherapy scheme as first-line treatment included Oxaliplatin (82% FOLFOX and 18% XELOX), in subsequent lines the most used scheme was FOLFIRI.

55% of patients received monoclonal antibody plus chemotherapy in first-line treatment and 77% in second-line, being Bevacizumab the most used medication. In this group of patients better response rates were reported. Progression-free survival was similar for all lines of treatment, independent of the chemotherapy scheme used, with an average of 5.5 months.

11% of patients were carried to metastasectomy, of which 43% was stage IV when diagnosed. 28% was wild-type KRAS. All of them underwent primary tumor resection. 50% required systemic chemotherapy prior to metastasectomy was performed, 6 cycles of FOLFOX plus Bevacizumab were used in all cases. Overall survival reported was 74 months, compared to 39 months in the group of patients that didn't undergo metastasectomy (p = 0.001).

21% of patients who received FOLFOX during treatment presented significant neuropathy and 11% presented gastrointestinal toxicity with FOLFIRI.

Of 108 patients who received Bevacizumab, 5.5% presented thrombotic events and 1.8% gastrointestinal hemorrhage. With Cetuximab significant toxicity was not reported.

Conclusion

In the studied population, demographic characteristics and tumor response to treatment were similar to those described in world literature. No chemotherapy scheme showed superiority in response rates, associated toxicity was predictable. Biologic therapies presented higher response rates when compared to conventional chemotherapy and toxicity profile was also predictable. Patients who underwent metastasectomy showed a higher overall survival.