Abstract
PurposeThe primary aim of this retrospective study was to describe the treatment patterns according to the type of treatment received by patients with metastatic colorectal cancer (mCRC) in Spain.MethodsThis was a retrospective, observational, multicenter study performed by 33 sites throughout Spain that included consecutive patients aged 18 years or older who had received or were receiving treatment for mCRC.ResultsAt the time of inclusion, of the 873 evaluable patients, 507 (58%) had received two lines, 235 (27%) had received three lines, 106 (12%) had received four lines, and the remaining patients had received up to ten lines. The most frequent chemotherapy schemes were the FOLFOX or CAPOX regimens (66%) for first-line treatment, FOLFOX, CAPOX or FOLFIRI (70%) for second-line treatment, and FOLFOX, FOLFIRI or other fluoropyrimidine-based regimens for third- and fourth-line (over 60%) treatment. Sixty percent of patients received targeted therapy as part of their first-line treatment, and this proportion increased up to approximately 70% of patients as part of the second-line of treatment. A relevant proportion of patients were treated with unknown KRAS, and especially the BRAF, mutation statuses.ConclusionsThis study reveals inconsistencies regarding adherence to the recommendations of the ESMO guidelines for the management of mCRC in Spain. Improved adherence to the standard practice described in such guidelines for the determination of RAS and BRAF mutation statuses and the use of targeted therapies in first-line treatment should be considered to guarantee that patients can benefit from the best therapeutic approaches available.
Highlights
Colorectal cancer (CRC) is a leading cause of cancerrelated morbidity and mortality worldwide, and its global burden is expected to increase in the coming years [1]
Regarding KRAS/NRAS/BRAF mutation status, we considered that the patient was nonadherent with all three ESMO guidelines if the KRAS mutation status was unknown; non-adherent with the 2014 and 2016 ESMO guidelines if the NRAS mutation status was unknown in patients with KRASwt; and non-adherent with the 2016 ESMO guidelines if the BRAF mutation status was unknown in patients RASwt
The most frequent chemotherapy schemes were the FOLFOX or CAPOX regimens (66%) for first-line treatment, FOLFOX, CAPOX or FOLFIRI (70%) for second-line treatment, and FOLFOX, FOLFIRI or other fluoropyrimidine-based regimens for third- and fourth-line treatment (Fig. 1)
Summary
Colorectal cancer (CRC) is a leading cause of cancerrelated morbidity and mortality worldwide, and its global burden is expected to increase in the coming years [1]. The clinical outcome of metastatic (m) CRC has improved in the last decade, probably as a consequence of the availability of improved systemic treatment options and the improvements in the management of the disease. 12 Oncology Dapartment, Hospital Universitario Reina Sofía, Av. Menendez Pidal, s/n, 14004 Córdoba, Spain. Management of mCRC should be guided by the available clinical practice guidelines (CPGs) [3, 4]. Adherence to the guidelines for managing CRC may vary and has been reported as acceptable in some countries [6, 8] and suboptimal in others [7]. Incomplete or unreliable tests in some laboratories could affect adherence to biomarker testing guidelines [11]
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