Abstract 418P
Background
Retrospective studies and meta-analysis suggest that UPTR confers a survival benefit in patients with asymptomatic unresectable mCRC undergoing chemotherapy, however a consensus of its role in routine clinical practice in the current era of targeted therapies is lacking. This study aimed to analyse the survival benefit of UPTR in the context of tumour location and mutational status in patients receiving chemotherapy and targeted therapy.
Methods
A retrospective analysis of survival in asymptomatic synchronous irresectable mCRC patients treated with a first-line anti-VEGF or anti-EGFR inhibitor in seven prospective trials of the Spanish TTD group, according to UPTR, tumour sidedness and mutational profiling.
Results
Of 1334 eligible patients, 642 (48%) had undergone UPTR. UPTR was associated with significantly longer overall survival (OS; 25.0 vs 20.3 months; HR 1.30, 95%CI 1.15-1.48, p<0.0001) as compared with no UPTR. UPTR was associated with significant OS benefit in both left-sided (HR 1.38, 95%CI 1.13-1.69; p=0.002) and right-sided (HR 1.39, 95%CI 1.00-1.94; p=0.049) tumours, RASwt (HR 1.29, 95%CI 1.05-1.60; p=0.016) and BRAFwt (HR 1.49, 95%CI 1.21-1.84; p=0.0002) tumours, and treatment with anti-EGFRs(HR 1.47, 95%CI 1.13-1.92; p=0.004) and anti-VEGFs (HR 1.25, 95%CI 1.08-1.44; p=0.003). Multivariate analysis identified the number of metastatic sites, RAS status, primary tumour location and UPTR as independent prognostic factors for OS.
Conclusions
This study supports UPTR before first-line anti-EGFR or anti-VEGF targeted therapy in right and left-sided asymptomatic unresectable synchronous mCRC patients. RAS/BRAF mutational status should also be taken into account in the therapeutic algorithm for this population.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD).
Funding
Roche Farma SA.
Disclosure
M. Benavides: Financial Interests, Personal, Advisory Board, Advisory: Amgen; MSD; Sanofi; BMS; Amgen; Non-Financial Interests, Other, Samples provider: Guardant Health. J.M. Vieitez: Financial Interests, Personal, Other, Conference support: Roche; Amgen. F. Rivera: Financial Interests, Personal, Advisory Role: Roche; Merck-Serono; Amgen; MSD; BMS; Lilly; Celgene; Sanofi-Aventis; Servier; AstraZeneca; Bayer; Financial Interests, Personal, Other, Research funding: Roche; Merck-Serono; Amgen; MSD; Lilly; Celgene; Sanofi-Aventis; Servier; Bayer; Financial Interests, Personal, Invited Speaker: Roche; Merck-Serono; Amgen; MSD; BMS; Lilly; Celgene; Sanofi-Aventis; Servier; Bayer; Financial Interests, Personal, Other, Grant support: Amgen. M.J. Safont Aguilera: Financial Interests, Personal, Advisory Role: Roche; Merck-Serono; Amgen; MSD; BMS; Sanofi-Aventis; Servier; Bayer; Financial Interests, Personal, Other, Personal Fees: Merck-Serono; Amgen; Roche; Sanofi-Aventis; Servier. M. Valladares-Ayerbes: Financial Interests, Personal, Other, Grants: Roche; Financial Interests, Personal, Other, Personal fees: Roche; Merck; Amgen; Sanofi; Servier; Bayer; Celgene. V. Alonso: Financial Interests, Personal, Other, Grants: Amgen; Merck; Servier; Roche; Sanofi. E. Aranda Aguilar: Financial Interests, Personal, Advisory Role: Amgen; Bayer; Celgene; Merck; Roche; Sanofi. All other authors have declared no conflicts of interest.