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Title: Impact of primary tumour site on Bevacizumab efficacy in metastatic colorectal cancer.
Epworth Authors: Zimet, Allan
Jennens, Ross
Other Authors: Wong, Hui-Li
Lee, Belinda
Field, Kathryn
Lomax, Anna
Tacey, Mark
Shapiro, Jeremy
McKendrick, Joseph
Yip, Desmond
Nott, Louise
Richardson, Gary
Tie, Jeanne
Kosmider, Suzanne
Parente, Phillip
Lim, Lionel
Cooray, Prasad
Tran, Ben
Desai, Jayesh
Wong, Rachel
Gibbs, Peter
Keywords: Colorectal Neoplasms
Colorectal Cancer
Neoplasms, Colorectal
Metastatic Colorectal Cancer
Personalized Medicine
Biological Therapy
Disease-Free Survival
Department of Oncology, Epworth Hospital, Richmond, Victoria, Australia
Cancer Services Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Feb-2016
Publisher: Elsevier
Citation: Clinical Colorectal Cancer. 2016 Feb 13. pii: S1533-0028(16)30019-6
Abstract: BACKGROUND: With an ever-increasing focus on personalized medicine, all factors known to affect treatment response need to be considered when defining optimal therapy for individual patients. While the prognostic impact of primary tumor site on colorectal cancer (CRC) outcomes is established, emerging data suggest potential differences in response to biologic therapies. We studied the impact of tumor site on bevacizumab efficacy in patients with metastatic CRC. PATIENTS AND METHODS: We analyzed data of patients in an Australian prospective multicenter metastatic CRC (mCRC) registry who received first-line chemotherapy. Tumor site was defined as right colon, cecum to transverse; left colon, splenic flexure to rectosigmoid; and rectum. Kaplan-Meier and Cox models were used for survival analyses. RESULTS: Of 926 patients, 297 had right colon, 354 left colon, and 275 rectum primary disease. Median age was 68.6, 65.9, and 63.3 years, respectively (P = .001). Right colon disease was significantly associated with intraperitoneal spread (P < .0001), while left colon and rectum disease preferentially metastasized to the liver and lungs, respectively (P < .0001 in both settings). A total of 636 patients (68.7%) received bevacizumab. Progression-free survival was superior for bevacizumab-treated patients in all groups but appeared greatest in right colon disease (hazard ratio, 0.46; 95% confidence interval, 0.36-0.60; P ≤ .001). Overall survival was longest in patients with disease of the rectum, followed by left colon and right colon (median, 26.2, 23.6, and 18.2 months, respectively; P = .0004). CONCLUSION: Tumor site appears to be prognostic in mCRC, with rectum and right colon disease associated with the best and worst outcomes, respectively. Patients who received bevacizumab in addition to chemotherapy had superior outcomes, with the effect appearing greatest in patients with right colon disease.
DOI: 10.1016/j.clcc.2016.02.007
PubMed URL:
ISSN: 1533-0028
Journal Title: Clinical Colorectal Cancer
Type: Journal Article
Affiliated Organisations: Systems Biology and Personalised Medicine Division, Walter & Eliza Hall Institute of Medical Research (WEHI), Parkville, Melbourne, Victoria, Australia.
Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia.
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Eastern Health, Department of Medical Oncology, Melbourne, Victoria, Australia.
Department of Health Education and Research, Melbourne EpiCentre, The Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia.
Cabrini Health, Department of Oncology, Malvern, Melbourne, Victoria, Australia.
Department of Medicine, Nursing & Health Sciences, Monash University, Parkville, Melbourne, Victoria, Australia.
Western Health, Department of Medical Oncology, Footscray, Melbourne, Victoria, Australia.
Department of Medical Oncology, Canberra and Calvary Hospitals, Garran, Australian Capital Territory, Australia.
Department of Medical Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
Department of Oncology, Ringwood Private Hospital, Ringwood East, Victoria, Australia.
Type of Clinical Study or Trial: Prospective Cohort Study
Appears in Collections:Cancer Services

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