Treatment patterns among metastatic colorectal cancer patients by line of therapy and original stage of diagnosis.

Abstract

e14013 Background: National Comprehensive Cancer Network (NCCN) guidelines recommend use of approved biologics combined with common chemotherapy agents for treatment of metastatic colorectal cancer (CRC). Five classes of chemotherapy/biologics are available for treatment of CRC. Methods: Adult patients with a diagnosis of CRC between 01/01/05 and 05/31/10 were identified from the Impact Intelligence Oncology Management (IIOM) registry. Patients with either stage 4 CRC at original diagnosis or development of a metastasis were included. Registry data included original date of diagnosis and stage information. Linked healthcare claims from a large US health insurance database affiliated with OptumInsight were used to identify lines of therapy and patient characteristics (e.g., development of metastases). Lines of therapy were based on patients’ use of chemotherapy/biologic agents after becoming metastatic. Treatment regimens were assessed and stratified by line of therapy (1st, 2nd, 3rd, 4th) and stage at diagnosis (0-2, 3, 4, unknown). Results: 16% of the 598 study patients who developed metastasis received no chemotherapy. Of those who did, 84%, 52%, 27%, and 14% received a 1st, 2nd, 3rd, and 4th line of therapy, respectively. 71% of patients who progressed from stage 0-2 or 3 received a 2nd line compared to 90% of patients who initially presented with stage 4 CRC. In the 1st line, 59% received an oxaliplatin-based regimen, 15% received an irinotecan-based regimen, and 11% received 5-FU alone. In 2nd and 3rd line therapy, percentages of patients treated with irinotecan-based regimens increased to 45% and 50%, respectively, and use of oxaliplatin-based regimens dropped to 27% and 16%, respectively. Overall, use of anti-EGFR agents increased steadily from 4% in the 1st line to 12%, 29%, and 38%, respectively in the 2nd, 3rd, and 4th lines. Conclusions: Patients who presented with stage 4 CRC had the highest rates of chemotherapy use. Despite NCCN guidelines, 11% of patients received 5-FU monotherapy as 1st line treatment.