Population-based patterns of systemic therapy use in liver-limited metastatic colorectal cancer (mCRC).

Abstract

576 Background: Treatment of liver-limited mCRC frequently involves systemic therapy and surgery. Our aims were to 1) explore the use and choice of systemic therapy pre- and post-liver resection and 2) examine if specific patient characteristics or therapy regimens were associated with improved outcomes. Methods: Patients diagnosed with liver-limited mCRC from 2006 to 2007 in British Columbia were reviewed. Summary statistics were conducted to describe surgical and systemic treatment patterns. Kaplan-Meier methodology was used to characterize the relationship between systemic regimen and overall survival (OS). Results: Among 374 patients, 42% were aged ≥70 years, 60% were men, 29/39/32% were ECOG 0/1/2+, 80% had primary tumor surgery, and 68% received prior adjuvant chemotherapy. For liver metastases, 95 (26%) were offered hepatic resection. Compared to those who did not receive surgery, resected patients were younger (median 60 vs. 69, p<0.01), better functioning (ECOG 0/1 86% vs. 55%, p<0.01), and had smaller (median 3 vs. 4 cm, p<0.03) and fewer (median 2 vs. 4, p<0.01) lesions. They also had improved median OS (11.0 vs. 9.4 months, p<0.01). Surgical patients having a solitary lesion (p=0.03) or a largest lesion ≤3 cm (p=0.02) experienced better survival. Performance status (HR=0.54, p=0.35), age (HR=0.47, p=0.30), and sex (HR=0.68, p=0.48) did not impact outcomes. Among patients who underwent hepatic resection, 80% received some form of chemotherapy (Table). Median OS did not differ significantly based on choice of chemotherapy: FOLFOX (13.9 months), FOLFIRI (11.5 months), and capecitabine (10.9 months) (p=0.44) or receipt of bevacizumab: yes (14.5 months) vs. no (11.1 months) (p=0.57). Conclusions: In this population-based cohort of liver-limited mCRC patients, hepatic resection was associated with improved survival. Among those offered some form of peri-operative therapy, FOLFOX, FOLFIRI, and capecitabine, either alone or in combination with bevacizumab, appear to be reasonable treatment options. [Table: see text]