Patterns of progression, treatment of progressive disease and post-progression survival in the New EPOC study.

Tim Iveson, John N Primrose, John A Bridgewater, Tim S Maughan, David Cunningham, O James Garden, Mike Radford, Andrea Corkhill, Elizabeth Dixon, Louise Stanton, Tom Maishman, Tamas Hickish, Siân A Pugh, Charlotte Rees, Myrddin Rees, Joanne Hornbuckle, Ajith K Siriwardena, Derek A O'Reilly, Juan W Valle, Meg Finch-Jones, Stephen Falk, Alexandre Ball, Megan Bowers

Journal: British journal of cancer 2017;115(4):420-4

PMID: 27434036

Free Full Text on PubMed Central View on PubMed

Abstract

BACKGROUND

The addition of cetuximab (CTX) to perioperative chemotherapy (CT) for operable colorectal liver metastases resulted in a shorter progression-free survival. Details of disease progression are described to further inform the primary study outcome.

METHODS

A total of 257 KRAS wild-type patients were randomised to CT alone or CT with CTX. Data regarding sites and treatment of progressive disease were obtained for the 109 (CT n=48, CT and CTX n=61) patients with progressive disease at the cut-off date for analysis of November 2012.

RESULTS

The liver was the most frequent site of progression (CT 67% (32/48); CT and CTX 66% (40/61)). A higher proportion of patients in the CT and group had multiple sites of progressive disease (CT 8%, 4/48; CT and CTX 23%, 14/61 P=0.04). Further treatment for progressive disease is known for 84 patients of whom 69 received further CT, most frequently irinotecan based. Twenty-two patients, 11 in each arm, received CTX as a further line agent.

CONCLUSIONS

Both the distribution of progressive disease and further treatment are as expected for such a cohort. The pattern of disease progression seen is consistent with failure of systemic micrometastatic disease control rather than failure of local disease control following liver surgery.

Address: University Surgery and Cancer Sciences Division, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.; Southampton Clinical Trials Unit, Southampton, UK.; Royal Bournemouth Hospital, Bournemouth, UK.; Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.; Department of Upper Gastrointestinal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.; University of Manchester/The Christie NHS Foundation Trust, Manchester, UK.; Department of Hepatopancreatobiliary Surgery, Central Manchester NHS Foundation Trust, Manchester, UK.; Institute of Cancer Sciences, University of Manchester, Manchester, UK.; Hepatobiliary Unit, Manchester Royal Infirmary, Manchester, UK.; Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.; Hepatobiliary Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.; Department of Medical Oncology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.; University Hospital Southampton NHS Foundation Trust, Southampton, UK.; Bournemouth University, Bournemouth, UK.; Poole Hospital, Poole, UK.; Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK.; Department of Medicine, Gastrointestinal and Lymphoma Units, The Royal Marsden Hospital NHS Foundation Trust, London, UK.; Department of Oncology, University of Oxford, Oxford, UK.; University College London Cancer Institute, London, UK.

DOI: 10.1038/bjc.2016.208

Link outs

Free resources

Full Text Sources:

Medical:

https://medlineplus.gov/colorectalcancer.html

Other Literature Sources:

https://scite.ai/reports/27434036

Miscellaneous:

https://assays.cancer.gov/CPTAC-1550

Subscription / membership required

Full Text Sources:

https://doi.org/10.1038/bjc.2016.208

MeSH Terms: Aged, Antineoplastic Combined Chemotherapy Protocols, Camptothecin, Capecitabine, Cetuximab, Colorectal Neoplasms, Disease Progression, Disease-Free Survival, Female, Hepatectomy, Humans, Irinotecan, Leucovorin, Liver Neoplasms, Male, Metastasectomy, Middle Aged, Neoadjuvant Therapy, Organoplatinum Compounds, Oxaliplatin