Clinical outcomes of intensive versus less intensive first-line chemotherapy for metastatic colorectal cancer

• Published in: Future oncology (London, England) England), 2023-12, Vol.19 (39), p.2569-2583
• Main Authors: Yamazaki, Kentaro, Yuki, Satoshi, Oki, Eiji, Sano, Fumikazu, Makishima, Misako, Aoki, Kenichi, Hamano, Tetsutaro, Yamamoto, Kouji
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Bevacizumab; Camptothecin - therapeutic use; Colonic Neoplasms - drug therapy; colorectal cancer; Colorectal Neoplasms - pathology; first-line treatment; Fluorouracil - therapeutic use; Humans; intensive therapy; less intensive therapy; Leucovorin - therapeutic use; molecularly targeted agents; overall survival; real-world data; Rectal Neoplasms - drug therapy; Retrospective Studies; time to treatment failure
• ISSN: 1479-6694; 1744-8301
• DOI: 10.2217/fon-2022-1284

Physicians determine the treatment regimen for metastatic colorectal cancer on a case-by-case bases, according to the individual disease characteristics. We retrospectively compared the baseline characteristics and efficacies of first-line treatment among patients with metastatic colorectal cancer who received intensive therapy involving fluoropyrimidine plus oxaliplatin and/or irinotecan, potentially with molecularly targeted agents as well, versus less intensive fluoropyrimidine and/or bevacizumab therapy. Data were collected from a medical claims database. The efficacy outcomes were: time to treatment failure, time to first subsequent therapy and overall survival. The less intensive therapy group (n = 633) had higher median age, lower daily activity levels and shorter time to treatment failure, time to first subsequent therapy and overall survival than the intensive therapy group (n = 3829). Combination therapy with molecularly targeted agents and bevacizumab improved treatment efficacy outcomes in the intensive and less intensive groups, respectively. Patient age and daily activity levels were important factors for determining treatment intensity. In this study we performed a real-world data analysis of treatment for advanced colorectal cancer that had spread to other parts of patients’ bodies, by investigating the medical records of 4462 patients. We wanted to see how well different treatments worked and what kinds of patients received them. We found that the most important factors when choosing between different treatments were the patient’s age and how well they could perform their everyday tasks. We found that using specialized medicines in the intensive treatment group, and a drug called bevacizumab in the less intensive group, resulted in better patient outcomes. In real-world data on first-line treatment of patients with mCRC, age and daily activity levels were key in choosing intensive or less intensive therapy. Molecularly targeted agents improved outcomes with intensive therapy.