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Open Access 30-08-2023 | Targeted Therapy | Colorectal Cancer

Chemotherapy and Targeted Therapy Strategies in Patients with Unresectable or Borderline Resectable Metastatic Colorectal Cancer: Evidence for a Lack of Focus on Resection Rates

Authors: Jan Zmuc, MD, Jan Heil, MD, Caroline Herfarth, MD, Wolf O. Bechstein, MD, Christine Koch, MD, Jörg Trojan, MD, Andreas A. Schnitzbauer, MD

Published in: Annals of Surgical Oncology | Issue 12/2023

Abstract

Background and aims

Chemotherapy (CTx) with targeted therapy (TT) have increased the overall response rate (ORR) and improved survival in unresectable or borderline resectable metastatic colorectal cancer (mCRC). However, the resection rate is an endpoint with often suboptimal expert involvement. The aim was to investigate whether the improvements in ORR have translated to improved resection rates (RR).

Study design

A systematic literature search was performed using the PICO process.

Statistical analysis

Odds ratios, and 95% confidence intervals (OR, 95% CI) were analyzed for ORR and RR using dichotomous values with the Mantel-Haenszel method. Progression-free survival (PFS) and overall survival (OS) were analyzed using the inverse-variance method and displayed as hazard ratios and 95% confidence intervals (HR, 95% CI).

Results

The literature search returned 469 records. Sixteen articles with 5724 patients were selected for analysis. The qualitative analysis revealed low and moderate risk of bias endpoints. Higher ORR was observed with CTx + TT versus CTx only (OR: 0.62 [95% CI 0.45; 0.82], p = 0.002) and with triplet CTx + TT versus doublet CTx + TT (OR: 0.61 [95% CI 0.46; 0.81], p < 0.001). PFS and OS were improved by use of TT (HR: 0.68–0.84; p < 0.001 to 0.04). The overall RR was low (< 15%) and did not improve in the same way as the other endpoints.

Conclusion

The ORR and survival rates in unresectable and borderline resectable mCRC were improved by modern CTx and TT that did not translate into higher RR, mostly due to the lack of expert involvement.

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Title: Chemotherapy and Targeted Therapy Strategies in Patients with Unresectable or Borderline Resectable Metastatic Colorectal Cancer: Evidence for a Lack of Focus on Resection Rates
Authors: Jan Zmuc, MD
Jan Heil, MD
Caroline Herfarth, MD
Wolf O. Bechstein, MD
Christine Koch, MD
Jörg Trojan, MD
Andreas A. Schnitzbauer, MD
Publication date: 30-08-2023
Publisher: Springer International Publishing
Keywords: Targeted Therapy
Bevacizumab
Cetuximab
Colorectal Cancer
Colorectal Cancer
Cytostatic Therapy
Published in: Annals of Surgical Oncology / Issue 12/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-14049-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Chemotherapy and Targeted Therapy Strategies in Patients with Unresectable or Borderline Resectable Metastatic Colorectal Cancer: Evidence for a Lack of Focus on Resection Rates

Abstract

Background and aims

Study design

Statistical analysis

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aims

Study design

Statistical analysis

Results

Conclusion

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