Abstract 423P
Background
Triplet chemotherapy (fluorouracil, oxaliplatin, irinotecan) plus bevacizumab (FOLFOXIRI-B) is a first-line treatment option for patients with metastatic colorectal cancer (mCRC). Its benefit on overall survival compared to doublet chemotherapy plus bevacizumab has been shown in several phase III randomized controlled trials and a recent meta-analysis. However, the implementation of this regimen by medical oncologists in daily practice is unknown. We evaluated the current prescription rate of FOLFOXIRI-B in mCRC and investigated the perspectives of medical oncologists towards this treatment option.
Methods
This was a nationwide, one-week, multicenter, cross-sectional flash mob study. During a single week in March 2021, we retrieved clinical data of 282 currently diagnosed mCRC patients, while simultaneously interviewing 101 medical oncologists from 52 different hospitals in the Netherlands. Patient eligibility for treatment with FOLFOXIRI-B was estimated. We compared current practice to retrospective FOLFOXIRI-B prescription rates as documented by the Netherlands Cancer Registry.
Results
Since 2015-2018, the FOLFOXIRI-B prescription rate has increased from 2.4% to 8.9% in 2021. This means one in seven eligible patients is currently treated with FOLFOXIRI-B. Eighty-six percent of medical oncologists discuss FOLFOXIRI-B as a treatment option in daily practice, of which 56% generally communicate a preference for a chemotherapy doublet over FOLFOXIRI-B to patients. These oncologists reported a significantly lower awareness of literature regarding FOLFOXIRI-B compared to oncologists that claimed not to communicate a preference regularly. Toxicity was the most reported reason to prefer an alternative regimen.
Conclusions
FOLFOXIRI-B prescription rates have marginally increased in the last 5 years. Considering most medical oncologists report to discuss this treatment option, the prescription rate is below what would be expected considering the 4.9 month survival benefit with FOLFOXIRI-B treatment. We show that awareness of guidelines and trial data contributes to the discussion of available treatment options by medical oncologists, emphasizing the need for repeated and continuing medical education.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
G.M. Bol.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.