Colorectal Cancer Treatment Patterns Research Articles

Diabetes mellitus and colorectal carcinoma outcomes: a meta-analysis.

The impact of diabetes mellitus (DM) on colorectal cancer (CRC) outcomes remains unknown. We studied this by conducting a meta-analysis to evaluate (1) CRC outcomes with and without DM and (2) treatment patterns. We searched PubMed, EMBASE, Google Scholar, and CINAHL for full-text English studies from 1970 to 12/31/2017. We searched keywords, subject headings, and MESH terms to locate studies of CRC outcomes/treatment and DM. Studies were evaluated by two oncologists. Of 14,332, 48 met inclusion criteria. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, we extracted study location, design, DM definition, covariates, comparison groups, outcomes, and relative risks and/or hazard ratios. We utilized a random-effects model to pool adjusted risk estimates. Primary outcomes were all-cause mortality (ACM), disease-free survival (DFS), relapse-free survival (RFS), and cancer-specific survival (CSS). The secondary outcome was treatment patterns. Forty-eight studies were included, 42 in the meta-analysis, and 6 in the descriptive analysis, totaling > 240,000 patients. ACM was 21% worse (OR 1.21, 95% CI 1.15-1.28) and DFS was 75% worse (OR 1.75, 95% CI: 1.33-2.31) in patients with DM. No differences were detected in CSS (OR 1.10, 95% CI 0.98-1.23) or RFS (OR 1.12, 95% CI 0.91-1.38). Descriptive analysis of treatment patterns in CRC and DM suggested potentially less adjuvant therapy use in cases with DM and CRC. Our meta-analysis suggests that patients with CRC and DM have worse ACM and DFS than patients without DM, suggesting that non-cancer causes of death in may account for worse outcomes.

Association of diabetes with colorectal cancer treatment and outcomes.

e18112 Background: Diabetes mellitus (DM) is associated with an increased incidence of colorectal cancer, but the impact of diabetes on colorectal cancer (CRC) prognosis and treatment patterns remains unknown. As outcomes in both CRC and DM have improved, appropriate co-management of the two diseases has become a priority to help patients live longer and healthier. Methods: A systematic search of PubMed, Embase, and CINAHL databases was performed to evaluate/assess the association of diabetes with colon cancer treatment patterns and outcomes, including recurrence rates (RR), disease free survival (DFS), colon cancer-specific (CSM) and all-cause mortality (ACM). We included English language peer-reviewed studies through November 2016 following the preferred reporting items of systematic reviews and meta-analyses (PRISMA) method. We applied STROBE quality criteria and conducted a random-effects meta-analysis. An inconsistency index (I2) was used to estimate the heterogeneity between studies. Results: After reviewing 2,611 reports, 35 studies were included that described an association of DM with CRC treatment patterns or outcomes. A meta-analysis of 14 studies that assessed (ACM) among 146,129 patients demonstrated an increased risk for ACM for CRC patients with DM (OR 1.28, 95% CI 1.16-1.42, I2 = 80%, P < .00001). No statistical significance was found in comparing 4 studies that looked at CSM (OR 0.91, 95% CI .72-1.14, I2 = 89%, P = 0.42). Analysis of 4 studies that assessed DFS found lower DFS in patients with DM (OR 1.75, 95% CI 1.33-2.31, I = 3%, P < .0001). Aggregating 3 studies that evaluated RFS demonstrated no clear association of DM and RFS(OR 1.12, CI 95% 0.91-1.38, I = 64%, P = .27). No consistent treatment discrepancies were noted in 6 studies that assessed the impact of DM on various CRC treatment modalities (receipt of surgery, chemotherapy, radiation). Conclusions: CRC patients with diabetes are at a greater risk for ACM and have worse DFS compared to those without DM. Analysis was limited due to study heterogeneity. We did not find consistent evidence that CRC is treated differently in patients with DM. Further study is warranted to clarify the mechanism of poor outcomes in CRC patients with DM and to improve survival.

Systemic Therapy for Advanced or Metastatic Colorectal Cancer: National Comprehensive Cancer Network Guidelines for Combining Anti‐Vascular Endothelial Growth Factor and Anti‐Epidermal Growth Factor Receptor Monoclonal Antibodies with Chemotherapy

Abstract During the past decade, new therapies for colorectal cancer have emerged that significantly prolong survival times. The introduction of these new agents has resulted in changes in colorectal cancer treatment patterns; clinicians are now able to optimize therapy and minimize toxicity by developing individualized patient treatment plans using a variety of agents. Biologic agents, including bevacizumab, an anti-vascular endothelial growth factor (VEGF) monoclonal antibody, and cetuximab and panitumumab, anti-epidermal growth factor receptor (EGFR) monoclonal antibodies, are among the new therapies now recommended by the National Comprehensive Cancer Network (NCCN) colon and rectal cancer treatment guidelines for use in first-, second-, and/or third-line colorectal cancer therapy. According to the NCCN guidelines, patients with advanced or metastatic colorectal cancer who are without contraindications are candidates to receive the anti-VEGF and anti-EGFR monoclonal antibodies at some point during the treatment course.