Abstract 67P
Background
Long-term survival in mCRC can be achieved with LT by metastasectomy (OP) or local ablative treatment (LAT). If not initially feasible, patients (pts) still might qualify for secondary LT (SLT) after response to primary chemotherapy (PCT). Evidence evaluating primary LT (PLT), PCT and SLT in one cohort is limited as most trials include pts for PCT or PLT only. Here, real-world evidence allows a comprehensive analysis.
Methods
For all mCRC pts treated at CCC MunichLMU from 2007-2021, routinely-collected health data were retrieved according to ESMO Guidance for Reporting Oncology real-World evidence (GROW). Survival data were retrieved from the Bavarian Cancer Registry. Median overall survival (OS) and survival after LT (LS) were analyzed for pts with PLT, PCT and SLT. Kaplan-Meier method and Cox regression were used. In multivariate analysis, survival was adjusted for prognostic factors including primary tumor sidedness, liver-limited disease status (LLD) and timing of metastasis (synchronous vs. metachronous).
Results
In total, 870 mCRC pts were identified. After exclusion of pts without curatively intended LT or without treatment against mCRC, 684 mCRC pts were evaluable. PLT (151 x OP, 13 x LAT) and PCT were performed in 164 and 520 pts, respectively. In the latter subgroup, SLT (94 x OP, 12 x LAT) was performed in 106 compared to 414 pts without ever LT (NoLT). OS was longer for pts with PLT than PCT (81.3 vs 41.6 months [mo], HR=0.495, 95%CI: 0.375-0.658, P<0.001). In multivariate analysis, PLT was superior to PCT in all examined subgroups, also in those with adverse prognosis (all P<0.05): right-sided mCRC (HR=0.543), synchronous mCRC (HR=0.602), recurrence <12 mo (HR=0.535), non-LLD (HR=0.662). Same was found for NoLT compared to SLT. Pts with PLT and SLT had comparable LS (74.4 vs. 68.5 mo, HR=1.03, 95%CI: 0.69-1.53, P=0.899).
Conclusions
Our results indicate a high relevance of LT, also in subgroups with inferior prognosis. Outcome is excellent and comparable, even if LT is performed after PCT. These findings underline the need for continuous evaluation of LT during the course of treatment against mCRC.
Legal entity responsible for the study
J.W. Holch.
Funding
Has not received any funding.
Disclosure
L. Weiss: Financial Interests, Personal, Invited Speaker: Roche, Servier; Financial Interests, Personal, Other: Amgen. C.B. Westphalen: Financial Interests, Personal, Invited Speaker: Bayer, BMS, Celgene, GSK, Roche, Servier, Sirtex, Taiho, Chugai, Amgen, Falk, MSD, Merck, Janssen, AstraZeneca; Financial Interests, Personal, Advisory Board: BMS, Celgene, Shire/Baxalta, Rafael, RedHill, Roche; Financial Interests, Personal, Other, Travel Support: Bayer, Celgene, RedHill, Roche, Servier, Taiho; Financial Interests, Personal, Expert Testimony: Janssen; Financial Interests, Personal and Institutional, Research Grant: Roche; Non-Financial Interests, Officer: AIO - Arbeitsgemeinschaft Internistische Onkologie (Germany); Non-Financial Interests, Advisory Role, Member of the EU Commission Mission Board for Cancer: EU Commission - DG RTD. K. Berger-Thürmel: Financial Interests, Personal, Research Grant: Roche Pharma AG. J. Ricke: Financial Interests, Personal, Advisory Board: Sirtex Medical, Boston Scientific, Terumo; Financial Interests, Institutional, Research Grant: Boston Scientific, AstraZeneca, Roche. M. von Bergwelt: Financial Interests, Personal, Advisory Role: Astellas, BMS, Kite/Gilead, Miltenyi, Mologen, MSD Sharp & Dohme, Novartis, Roche; Financial Interests, Institutional, Funding: Astellas, BMS, Kite/Gilead, Miltenyi, Mologen, MSD Sharp & Dohme, Novartis, Roche; Financial Interests, Personal, Other: Astellas, BMS, Kite/ Gilead, Miltenyi, Mologen, MSD Sharp & Dohme, Novartis, Roche. V. Heinemann: Financial Interests, Personal, Other: Amgen, Merck, Roche, Sanofi, SIRTEX, Servier, Pfizer, Pierre Fabre, AstraZeneca, MSD, GSK, Seagen, Bayer; Financial Interests, Personal, Advisory Board: Merck, Amgen, Roche, Sanofi, Sirtex, Bristol Myers Squibb, MSD, Novartis, Boehringer Ingelheim, Servier, Pierre Fabre, Celgene, Terumo, GSK, Oncosil, Nordic, Seagen; Financial Interests, Institutional, Funding: Merck, Amgen, Roche, Sanofi, Boehringer-Ingelheim, Sirtex, Bayer, Servier, Pfizer. J.W. Holch: Financial Interests, Personal, Advisory Board: Roche, Servier; Financial Interests, Personal, Other: Roche, Merck. All other authors have declared no conflicts of interest.