593P - Effect of resection of metastasis (ROM) and all 3, 4 and 5 active agents in metastatic colorectal cancer (mCRC) between 1995-2010

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anticancer Agents
Colon and Rectal Cancer
Surgical Oncology
Biological Therapy
Radiation Oncology
Presenter Hagen Kennecke
Citation Annals of Oncology (2014) 25 (suppl_4): iv167-iv209. 10.1093/annonc/mdu333
Authors H. Kennecke1, Y. Yin2, H. Lim3, D. Renouf1, L. Chen1, C. Speers1, W.Y. Cheung4
  • 1Medical Oncology, BC Cancer Agency, V5Z4E6 - Vancouver/CA
  • 2Population Outcomes, BC Cancer Agency, V5Z4E6 - Vancouver/CA
  • 3Medical Oncology, British Columbia Cancer Agency, Vancouver/CA
  • 4Medical Oncology, British Columbia Cancer Agency, V5Z4E6 - Vancouver/CA



Significant changes in surgical and systemic management of mCRC have occurred since 1995. The impact of exposure to All 3 Agents (5-Fluorouracil, Irinotecan, Oxaliplatin), All 4 (plus Bevacizumab) or All 5 (plus EGFR inhibitors [i]) and ROM is not well described. The objective of this study is to characterize the 15-year changes in surgical and systemic therapy and to measure associations between these treatments advances and outcomes.


All patients with relapsed or mCRC referred to the BC Cancer Agency diagnosed in 1995-96, 2000, 2003-04, 2006 and 2009-10 were included. Outcomes and systemic therapy data were prospectively collected. Information on ROM of liver, lung, ovarian, peritoneal and other sites was retrospectively abstracted. Cox regression analysis was conducted to examine associations between treatment variables and Overall Survival (OS), while accounting for era of diagnosis.


Variable p-value 1Year Hazard Ratio 95% CI
ROM vs no ROM <.0001 0.32 0.25 0.36
All 3 Agents vs. None <.0001 0.33 0.25 0.39
All 4 or 5 Agents vs.None <.0001 0.21 0.18 0.25
Only 1-2 Agents vs. None <.0001 0.68 0.62 0.74
A total of 3731 eligible patients were included with a median age of 68 years which did not differ between eras (p = .13). In 2009-10, 24% of treated patients underwent ROM, 42% received All 3 Agents, 54% received Bevacizumab and 18% received anti-EGFR agents. Patients who were only able to receive 1-2 agents had a median OS of 1.18 years (95% CI 1.09-1.25), those treated with All 3 Agents survived 1.93 years (95% CI 1.77-2.11) and those with All 4 or 5 Agents survived 2.49 years (95% CI 2.30-2.66). Median OS of ROM patients was 3.65 years (95% CI 3.25-3.95). Regression analysis demonstrated the independent prognostic effect of systemic therapy and ROM.


The introduction of 4 and 5 active agents in mCRC is associated with a measurable improvement OS with an incremental effect related to an increasing number of agents received. ROM is associated with prolonged survival, independent of systemic therapy. Effects are independent of era of diagnosis.


All authors have declared no conflicts of interest.