Tumor-size responses to first-line is a predictor of overall survival in metastatic colorectal cancer
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Early tumor shrinkage (ETS) has been reported to be associated with survival of metastatic colorectal cancer (mCRC) patients. Our aim was to analyze long-term tumor-size evolution, according to early mCRC best responses during the first-line therapy, to evaluate first best response-survival links.
Sixty-five patients with unresectable mCRCs, treated between 2010 and 2015, were included retrospectively in this descriptive monocenter study and grouped according to their RECIST 1.1 first-line best responses: progressive disease (PDfl), stable disease with tumor-size evolution between 0 and + 19% (SDfl+) or 0 and − 29% (SDfl–), and partial responders (PRs), who were classed PR with ETS (ETSfl) or without (PRfl). Tumor-size evolution and best tumor responses to each chemotherapy line were analyzed.
Tumor loads of ETSfl or PRfl mCRCs tended to remain inferior to their initial values: 60% of patients died with target lesion sums below baseline. For first-line SDfl+ or PDfl mCRCs, rapid tumor load increases continued during successive lines: > 80% died with target lesion sums above baseline. ETSfl mCRCs responded better to subsequent lines (37.5% second-line PR), whereas PDfl mCRCs remained refractory to other therapies (0% second- and third-line PR). Overall survival rates were significantly (p = 0.03) longer for the ETSfl group (29.9 [95% CI: 12.6–47.1] months) and shorter for the PDfl group (17.1 [95% CI: 1.5–37.5] months).
Tumors responding to first-line chemotherapy also responded better to subsequent lines, whereas PDfl mCRCs remained refractory, which may explain the better survival associated with ETSfl.
• Early shrinking tumors under first-line chemotherapy responded better to subsequent lines, maintaining low tumor loads, potentially explaining the link between early tumor shrinkage and overall survival of metastatic colorectal cancer (mCRC) patients.
• mCRCs progressing under first-line chemotherapy remained refractory to other therapies and their tumor loads increased rapidly.
• Even outside a clinical trial, an early first CT scan reevaluation with RECIST criteria 8 weeks after starting first-line therapy is crucial to determine long-term mCRC evolution.
KeywordsResponse evaluation criteria in solid tumors Colonic neoplasms Survival rate Tumor burden
Epidermal growth factor receptor
Early tumor shrinkage
Early tumor shrinkage at first line (defined at 8 weeks)
Metastatic colorectal cancer
Progressive disease at first line
Partial response at first line (without ETSfl: delayed response)
Response evaluation criteria in solid tumors
Stable disease at first line
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Olivier Lucidarme.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise. And no complex statistical methods were necessary for this paper.
Written informed consent was not required for this study because it is a retrospective study.
Institutional Review Board approval was not required because it was a retrospective study.
• performed at one institution
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