Conversion to resectability uncommon in trials of unresectable mCRC patients

04 Aug 2022
Conversion to resectability uncommon in trials of unresectable mCRC patients

In clinical trials of patients with unresectable metastatic colorectal cancer (mCRC), conversion to resectability (C2R) rarely happens, reveals a study.

Prioritizing chemotherapeutic agents that increase C2R may improve overall survival (OS) of patients with unresectable mCRC, the researchers said.

A team of researchers conducted a prospectively registered systematic review (PROSPERO CRD42015024104) of randomized clinical trials published after 2003. C2R with a primary outcome of OS was the exposure of interest.

Clinical trials were categorized according to the difference in C2R between study arms: <2 percent, 2 percent to 2.9 percent, and ≥3 percent. Associations were measured using generalized estimating equations with adjustments for multiple observations from the same trial.

Of the 2,902 studies identified, 30 (n=13,618 patients) were included in the meta-analysis. The median C2R was 7.3 percent (interquartile range [IQR], 5 percent to 12.9 percent), with maximum C2R at 28.6 percent in the FOLFOX/FOLFIRI+cetuximab arm.

In C2R between two arms of the same study, the median difference was 2.3 percent (IQR, 1.3 percent to 3.4 percent), with a maximum difference reaching 15.4 percent in FOLFOX/FOLFIRI+cetuximab vs FOLFOX/FOLFIRI.

The median OS for the entire cohort was 20.7 months (IQR, 18.9‒22.7 months), with a between-group difference of 1.3 months (IQR, ‒1.2 to 3.6 months). Between the two study arms with <2 percent C2R difference, the median survival difference was 0.8 month compared with 1.6 months with ≥3 C2R rates.

Increasing C2R showed an incremental dose-effect response on OS (p=0.021). In addition, higher response rates were associated with C2R rates (p=0.003).

“Metastasectomy in patients with metastatic mCRC confers a significant survival benefit,” the researchers said.

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