597P - Overall survival in metastatic colorectal cancer (mCRC) patients receiving 2nd-line therapy: a systematic review

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Anti-Cancer Agents & Biologic Therapy
Colon Cancer
Rectal Cancer
Presenter Amber Martin
Authors A.L. Martin1, Y. Xu2, K. Knopf3, S.U. Iqbal4, J. Jasso-Mosqueda5
  • 1United Biosource Corporation, 02420 - Lexington/US
  • 2Health Economics, United Biosource Corporation, 02420 - Lexington/US
  • 3Oncology, California Pacific Medical Center, San Francisco/US
  • 4Global Evidence And Value Development, Sanofi, 02142 - Cambridge/US
  • 5Global Evidence & Value Development, Sanofi, CHILLY-MAZARIN/FR

Abstract

Background

Currently, oxaliplatin or irinotecan-based regimens are the standard of care (SOC) in 1st– and 2nd-line therapy of mCRC, often combined with bevacizumab or an EGFR inhibitor. A systematic literature review was conducted to address gaps in the current evidence and gain an understanding of the clinical efficacy of 2nd-line chemotherapy in patients with mCRC.

Methods

Searches were conducted in EMBASE, PubMed, CENTRAL, and key congresses using keywords for CRC and chemotherapy to identify relevant randomized trials assessing 2nd-line clinical efficacy, published between 1992 and April 2012.

Results

Twenty-three primary trials evaluating 2nd-line treatment of mCRC were identified for inclusion. Chemotherapeutic agents investigated included irinotecan monotherapy (k = 11), FOLFOX4 (k = 6), FOLFIRI (k = 4), IROX (k = 3), irinotecan/5-FU/FA (k = 3) and IRIS (k = 1). FU-based regimens were the most common prior therapy, with 13 studies reporting that 100% of patients received FU as 1st-line therapy for metastatic disease. Eight studies excluded patients who previously received irinotecan. Of the included studies, the VELOUR trial, comparing aflibercept + FOLFIRI versus FOLFIRI, was the only trial evaluating the current SOC (FOLFIRI based regimens) in patients who received oxaliplatin-based chemotherapy as a 1st-line agent. Overall survival (OS) ranged from 6.4 to 18 mos across studies. The addition of specific targeted agents to chemotherapy regimens demonstrated significant incremental survival gains. Addition of bevacizumab to FOLFOX4 in the 2nd-line setting was associated with a median OS of 12.9 mos, compared with 10.8 mos for FOLFOX4 alone. Similarly, the addition of panitumumab to FOLFIRI improved median OS from 12.5 mos to 14.5 mos in KRAS wild type patients and addition of aflibercept improved median OS from 12.1 mos to 13.5 mos.

Conclusions

OS in 2nd-line trials showed significant survival gains when targeted agents were added to chemotherapy regimens. However, variability in treatment choices, prior chemotherapy regimen, patient selection and study approaches may hamper efforts to conduct reliable pooled analyses on outcomes to examine comparative effectiveness. VELOUR was one of the few trials that investigated patients who had received the current SOC in their 1st-line therapy.

Disclosure

A.L. Martin: I am an employee of United BioSource Corporation (UBC), which received funding from Sanofi to conduct the study on which this abstract is based.

Y. Xu: I am an employee of United BioSource Corporation (UBC), which received funding from Sanofi to conduct the study on which this abstract is based.

K. Knopf: I am a paid consultant of United BioSource Corporation (UBC), which received funding from Sanofi to conduct the study on which this abstract is based.

S.U. Iqbal: I am a paid employee of Sanofi which provided funding to conduct the study on which this abstract is based.

J. Jasso-Mosqueda: I am a paid employee of Sanofi which provided funding to conduct the study on which this abstract is based.