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Risk factors for brain metastases in patients with metastatic colorectal cancer

Date

08 Oct 2016

Session

Poster Display

Presenters

Troels Christensen

Citation

Annals of Oncology (2016) 27 (6): 149-206. 10.1093/annonc/mdw370

Authors

T.D. Christensen1, J.A. Palshof1, F.O. Larsen1, E. Høgdall2, T.S. Poulsen2, B.V. Jensen1, P. Pfeiffer3, M.K. Yilmaz4, I.J. Christensen2, D.L. Nielsen1

Author affiliations

  • 1 Department Of Oncology, Herlev and Gentofte Hospital, 2730 - Herlev/DK
  • 2 Department Of Pathology, Herlev and Gentofte Hospital, 2730 - Herlev/DK
  • 3 Department Of Oncology, Institute of Clinical Research, 5000 - Odense/DK
  • 4 Department Of Oncology, Aalborg University Hospital, 9100 - Aalborg/DK
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Background

Brain metastases (BM) from colorectal cancer (CRC) are rare and usually develop late in the disease. However, it has been suggested that more patients will be diagnosed with BM from CRC due to improved diagnostics and increased survival. The aim of this study was to identify biological and clinical characteristics that could predict later BM development in long surviving patient with metastatic (m) CRC.

Methods

We retrospectively reviewed a multicenter database and biobank encompassing consecutive patients with mCRC who all received cetuximab in combination with irinotecan as third-line treatment independently of RAS status between 2005 and 2008. We performed RAS (KRAS & NRAS), BRAF, and PIK3CA sequencing of DNA from primary tumor tissue.

Results

Totally, 480 patients were included in the study. BM were diagnosed in 42 patients (8.8 %) at median 29 months after mCRC diagnosis. Patient characteristics are shown in table 1. Patients with BM had a significantly longer survival from mCRC diagnosis than non-BM patients (32 months vs 28 months, p = 0.001). On univariate cox regression analysis the risk of developing BM was increased in patients with rectal cancer (Hazard ratio (HR) = 2.478, p = 0.005), metachronous metastatic disease (HR = 2.296, p = 0.013), and lung metastases at mCRC diagnosis (HR = 4.196, p 

Conclusions

The incidence of BM was 8.8 % in our cohort of long surviving patients with mCRC. Having lung metastases at mCRC diagnosis seems to be an independent risk factor for later BM development. Rectal cancer and metachronous metastatic disease were also linked to an increased risk of BM.

Patient characteristics

-BM 438 patients +BM 42 patients
Median age at CRC diagnosis 60 years 58 years
Rectal cancer 153 (35 %) 26 (62 %)
Metachronous metastatic disease 188 (43 %) 28 (67 %)
Lung metastases 130 (30 %) 26 (62 %)
RAS Mut 184 (42 %) 20 (48 %)
BRAF Mut 30 (7 %) 0
PIK3CA Mut 58 (13 %) 7 (16 %)

Clinical trial identification

Legal entity responsible for the study

Troels Dreier Christensen and Dorte Lisbet Nielsen

Funding

The Danish Cancer Society

Disclosure

All authors have declared no conflicts of interest.

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