Skip to main content

Advertisement

SpringerLink
Log in

Are There Strategies to Integrate the Continuum of Care for Metastatic Colorectal Cancer When Resources Are Limited?

  • Adjuvant Therapy for Colon Cancers (AB Benson III and A de Gramont, Section Editors)
  • Published:
Current Colorectal Cancer Reports

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Colorectal cancer is one of the most frequent neoplasias worldwide, affecting both men and women. Patients with inoperable or metastatic colorectal cancer (CRC) are candidates for palliative treatment with chemotherapy, which can significantly prolong survival. The number of active drugs has progressively increased over the past years, as well as available techniques directed towards resection or ablation of metastasis. Consequently, patients are able to live longer, with better quality of life. As new technologies become available, the treatments are becoming increasingly complicated, and the cost has increased in a proportion that most health systems can hardly afford. While the price of new therapies poses a challenge in more economically developed countries, it has a much greater impact in emerging and underdeveloped economies. In this article, we will discuss some strategies that could help dealing with this major problem, while reasonably maintaining the benefits of newer drugs and technologies to patient treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Howlader N NA, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA, editors. SEER Cancer Statistics Review, 1975-2012, based on November 2014 SEER data submission. MD: National Cancer Institute Bethesda; 2015. posted to the SEER web site.

  2. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013 [updated 2013; cited 07/24/2015]; Available from: http://globocan.iarc.fr.

  3. al. HLe, editor. CALGB/SWOG 80405: PHASE III trial of irinotecan/5-FU/leucovorin (FOLFIRI) or oxaliplatin/5-FU/leucovorin (mFOLFOX6) with bevacizumab (BV) or cetuximab (CET) for patients (pts) with expanded ras analyses untreated metastatic adenocarcinoma of the colon or rectum (MCRC) ESMO 2014; 2014.

  4. Chiara Cremolini FL, Gianluca Masi, Vittorina Zagonel, Francesca Bergamo, Lisa Salvatore, Enrico Cortesi, Gianluca Tomasello, Monica Ronzoni, Francesco Pinta, Alberto Zaniboni, Giuseppe Tonini, Angela Buonadonna, Domenico Amoroso, Claudia Sonaglio, Alfonso De Stefano, Corrado Boni, Giacomo Allegrini, Luca Boni, Alfredo Falcone; U.O. Oncologia Medica II, Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy; U.O. Oncologia Medica II, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Oncologia Medica I, Istituto Oncologico Veneto, IRCCS, Padova, Italy; Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Rome, Italy; Istituti Ospitalieri di Cremona, Cremona, Italy; Dipartimento di Oncologia Medica, Istituto Scientifico San Raffaele, Milano, Italy; Azienda Ospedaliero, Universitaria Città della Salute e della Scienza, Torino, Italy; Department of Medical Oncology, Casa di Cura Poliambulanza, Brescia, Italy; Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy; Dipartimento di Oncologia Medica, Istituto Nazionale Tumori, Aviano, Italy; Ospedale Versilia, Lido Di Camaiore, Italy; IRCCS Azienda Ospedaliera Universitaria San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy; Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Naples, Italy; Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy; U.O. Oncologia Medica, Azienda USL-5, Istituto Toscano Tumori, Pontedera, Italy; Clinical Trial Coordinating Center, AOU Careggi, Istituto Toscano Tumori, Firenze, Italy, editor. FOLFOXIRI plus bevacizumab (bev) versus FOLFIRI plus bev as first-line treatment of metastatic colorectal cancer (mCRC): Updated survival results of the phase III TRIBE trial by the GONO group. 2015 Gastrointestinal Cancers Symposium; 2015. J Clin Oncol. 2015; 33, (suppl 3; abstr 657).

  5. Heinemann V, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol. 2014;15(10):1065–75.

  6. Hoff PM, Ansari R, Batist G, Cox J, Kocha W, Kuperminc M, et al. Comparison of oral capecitabine versus intravenous fluorouracil plus leucovorin as first-line treatment in 605 patients with metastatic colorectal cancer: results of a randomized phase III study. J Clin Oncol. 2001;19(8):2282–92.

    CAS  PubMed  Google Scholar 

  7. Johnston LH, Carroll D. The psychological impact of injury: effects of prior sport and exercise involvement. Br J Sports Med. 2000;34(6):436–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Rothenberg ML, Oza AM, Bigelow RH, Berlin JD, Marshall JL, Ramanathan RK, et al. Superiority of oxaliplatin and fluorouracil-leucovorin compared with either therapy alone in patients with progressive colorectal cancer after irinotecan and fluorouracil-leucovorin: interim results of a phase III trial. J Clin Oncol. 2003;21(11):2059–69.

    Article  CAS  PubMed  Google Scholar 

  9. Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350(23):2335–42.

    Article  CAS  PubMed  Google Scholar 

  10. Cunningham D, Humblet Y, Siena S, Khayat D, Bleiberg H, Santoro A, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med. 2004;351(4):337–45.

    Article  CAS  PubMed  Google Scholar 

  11. Van Cutsem E, Tabernero J, Lakomy R, Prenen H, Prausova J, Macarulla T, et al. Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. J Clin Oncol. 2012;30(28):3499–506.

  12. Grothey A, Van Cutsem E, Sobrero A, Siena S, Falcone A, Ychou M, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet. 2013;381(9863):303–12.

  13. Seymour MT, Maughan TS, Ledermann JA, Topham C, James R, Gwyther SJ, et al. Different strategies of sequential and combination chemotherapy for patients with poor prognosis advanced colorectal cancer (MRC FOCUS): a randomised controlled trial. Lancet. 2007;370(9582):143–52.

    Article  CAS  PubMed  Google Scholar 

  14. Koopman M, Antonini NF, Douma J, Wals J, Honkoop AH, Erdkamp FL, et al. Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (CAIRO): a phase III randomised controlled trial. Lancet. 2007;370(9582):135–42.

    Article  CAS  PubMed  Google Scholar 

  15. Grothey A, Sargent D, Goldberg RM, Schmoll HJ. Survival of patients with advanced colorectal cancer improves with the availability of fluorouracil-leucovorin, irinotecan, and oxaliplatin in the course of treatment. J Clin Oncol. 2004;22(7):1209–14.

    Article  CAS  PubMed  Google Scholar 

  16. Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240(4):644–57. discussion 57-8.

    PubMed Central  PubMed  Google Scholar 

  17. Schrag D. The price tag on progress—chemotherapy for colorectal cancer. N Engl J Med. 2004;351(4):317–9.

    Article  CAS  PubMed  Google Scholar 

  18. Goss PE, Lee BL, Badovinac-Crnjevic T, Strasser-Weippl K, Chavarri-Guerra Y, St Louis J, et al. Planning cancer control in Latin America and the Caribbean. Lancet Oncol. 2013;14(5):391–436.

  19. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.

  20. Seal BS, Sullivan SD, Ramsey S, Shermock KM, Ren J, Kreilick C, et al. Medical costs associated with use of systemic therapy in adults with colorectal cancer. J Manag Care Pharm. 2013;19(6):461–7.

  21. Atun R, de Andrade LO, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, et al. Health-system reform and universal health coverage in Latin America. Lancet. 385(9974):1230–47. This is a very interesting article that discusses health reform in Latin America health system structure and population access to health care.

  22. Kantarjian H, Rajkumar SV. Why are cancer drugs so expensive in the United States, and what are the solutions? Mayo Clin Proc. 90(4):500–4. In this article, the author discusses the increasing cost of cancer drugs and reasons, implications and potential solutions to the problem.

  23. Saltz LB. Can money really be no object when cancer care is the subject? J Clin Oncol. 33(10):1093–4. Very important discussion on cost effective studies and acceptable limits for incorporating a new medication.

  24. Simkens LH, van Tinteren H, May A, Ten Tije AJ, Creemers GJ, Loosveld OJ, et al. Maintenance treatment with capecitabine and bevacizumab in metastatic colorectal cancer (CAIRO3): a phase 3 randomised controlled trial of the Dutch Colorectal Cancer Group. Lancet. 2015;385(9980):1843–52

  25. Prigerson HG, Bao Y, Shah MA, Paulk ME, LeBlanc TW, Schneider BJ, et al. Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol. 2015;1(6):778–84. doi:10.1001/jamaoncol.2015.2378.

  26. de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18(16):2938–47.

    PubMed  Google Scholar 

  27. Douillard JY, Cunningham D, Roth AD, Navarro M, James RD, Karasek P, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet. 2000;355(9209):1041–7.

    Article  CAS  PubMed  Google Scholar 

  28. Van Cutsem E, Köhne CH, Láng I, Folprecht G, Nowacki MP, Cascinu S, et al. Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J Clin Oncol. 2011;29(15):2011–9.

  29. Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M, et al. Final results from PRIME: randomized phase III study of panitumumab with FOLFOX4 for first-line treatment of metastatic colorectal cancer. Ann Oncol. 2015;25(7):1346–55.

    Article  Google Scholar 

  30. Tabernero J CA, Obermannova R, et al. editors. RAISE: A randomized, double-blind, multicenter phase III study of irinotecan, folinic acid, and 5-fluorouracil (FOLFIRI) plus ramucirumab (RAM) or placebo (PBO) in patients (pts) with metastatic colorectal carcinoma (CRC) progressive during or following first-line combination therapy with bevacizumab (bev), oxaliplatin (ox), and a fluoropyrimidine (fp). 2015 Gastrointestinal Cancers Symposium 2015 January 15-17, 2015; San Francisco, CA.

Download references

Author information

Authors and Affiliations

  1. Department of Radiology and Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 251, 5º andar - Oncologia Clinica, Sao Paulo, SP, 01246-000, Brazil

    Fernando Costa Santini, Maria Ignez Braghiroli & Paulo M. Hoff

  2. Centro de Oncologia, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 115 - Bela Vista, São Paulo, SP, 01308-050, Brazil

    Fernando Costa Santini, Maria Ignez Braghiroli & Paulo M. Hoff

Authors
  1. Fernando Costa Santini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Ignez Braghiroli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paulo M. Hoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Ignez Braghiroli.

Ethics declarations

Conflict of Interest

Fernando Costa Santini, Maria Ignez Braghiroli, and Paulo M. Hoff declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Adjuvant Therapy for Colon Cancers

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Santini, F.C., Braghiroli, M.I. & Hoff, P.M. Are There Strategies to Integrate the Continuum of Care for Metastatic Colorectal Cancer When Resources Are Limited?. Curr Colorectal Cancer Rep 11, 311–316 (2015). https://doi.org/10.1007/s11888-015-0294-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11888-015-0294-1

Keywords

Search

Navigation