Published in:
01-06-2019 | Colorectal Cancer | Colorectal Cancer
Does Sidedness Matter in Unresectable Colorectal Cancer?
Published in: Annals of Surgical Oncology | Issue 6/2019
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Emerging evidence during the last 5 years has shown that right-sided metastatic colorectal cancer has a very different biology and a poorer prognosis than left-sided disease (Table 1). This difference in outcomes by sidedness appears to extend to benefit from systemic therapy as well. Treatment directed against the epidermal growth factor receptor (EGFR) pathway appears to be significantly less effective for right-sided tumors than for left-sided tumors.1,2
Table 1
Summary of pivotal clinical trials showing overall survival stratified by primary tumor location
|
Trial
|
Treatment arms
|
Left-sided tumors
|
Right-sided tumors
|
||||||
|---|---|---|---|---|---|---|---|---|---|
|
No. of patients
|
Median OS (months)
|
HR (95% CI)
|
p value
|
No. of patients
|
Median OS (months)
|
HR (95% CI)
|
p value
|
||
|
CALGB/SWOG 804052
|
FOLFOX/FOLFIRI + bev
|
152
|
32.6
|
–
|
–
|
78
|
29.2
|
–
|
–
|
|
FOLFOX/FOLFIRI + cetux
|
173
|
39.3
|
0.77 (0.59–0.99)
|
0.04
|
71
|
13.7
|
1.36 (0.93–1.99)
|
0.10
|
|
|
FIRE-311
|
FOLFIRI + bev
|
149
|
28.0
|
–
|
–
|
50
|
23.0
|
–
|
–
|
|
FOLFIRI + cetux
|
157
|
38.3
|
0.63 (0.48–0.85)
|
0.002
|
38
|
18.3
|
1.31 (0.81–2.11)
|
0.28
|
|
|
CRYSTAL11
|
FOLFIRI
|
138
|
21.7
|
–
|
–
|
51
|
15.0
|
–
|
–
|
|
FOLFIRI + cetux
|
142
|
28.7
|
0.65 (0.50–0.86)
|
0.02
|
33
|
18.5
|
1.08 (0.65–1.81
|
0.76
|
|
|
PEAK12
|
FOLFOX + bev
|
54
|
32.0
|
–
|
–
|
14
|
21.0
|
–
|
–
|
|
FOLFOX + pani
|
53
|
43.4
|
0.84 (0.22–3.27)
|
NR
|
22
|
17.5
|
0.45 (0.08–2.49)
|
NR
|
|
|
PRIME12
|
FOLFOX
|
159
|
23.6
|
–
|
–
|
49
|
15.4
|
–
|
–
|
|
FOLFOX + pani
|
169
|
30.3
|
0.73 (0.57–0.93)
|
NR
|
39
|
11.1
|
0.87 (0.55–1.37)
|
NR
|
|