Treatment patterns and survival outcomes for patients receiving second-line treatment for metastatic colorectal cancer in the USA



Colorectal cancer is the third most common cause of cancer death in the USA. It is important to identify patients who may experience poor outcomes from available treatments.


In this retrospective observational study, treatment patterns and survival outcomes were described among adult patients from the Flatiron Health electronic medical records database who were treated with at least two lines of therapy for metastatic colorectal cancer in the USA between January 2013 and May 2018. Patients with rapid progression were defined as those whose time from start of first- to second-line therapy was ≤ 183 days.


A total of 14,315 patients formed the study cohort. The most common first-line treatments were FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) plus bevacizumab, received by 34.7% (n = 4962) of patients, followed by FOLFOX alone (17.1%, n = 2445). Of all patients, 6991 (48.9%) also received second-line anti-cancer therapy and of those, 3338 (47.7%) had rapid progression and 3653 (52.3%) did not. Median overall survival from the start of first- and second-line therapy was 20.8 months (95% CI 20.2–21.3) and 14.5 months (95% CI 13.9–15.0) for the entire study population, respectively. Median overall survival from the start of second-line therapy was 14.1 (95% CI 13.2–14.8) for patients with rapid progression and 14.6 months (95% CI 13.8–15.4) for patients without rapid progression.


Patients diagnosed with metastatic colorectal cancer lived less than 2 years in this real-world database. While the time to initiation of second-line therapy was by definition longer among patients without rapidly progressing disease, survival outcomes were comparable from initiation of second-line therapy.

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Fig. 1


  1. 1.

    Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30

    Article  Google Scholar 

  2. 2.

    Van Cutsem E et al (2014) Metastatic colorectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 25(Suppl 3):iii1–iii9

    Article  PubMed  Google Scholar 

  3. 3.

    NCCN. Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Colon Cancer V4.2018. 2018 December 13, 2018]; Available from: Accessed 13 Dec 2008

  4. 4.

    Tournigand C, André T, Achille E, Lledo G, Flesh M, Mery-Mignard D, Quinaux E, Couteau C, Buyse M, Ganem G, Landi B, Colin P, Louvet C, de Gramont A (2004) FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 22(2):229–237

    Article  CAS  Google Scholar 

  5. 5.

    McLean J, Rho YS, Kuruba G, Mamo A, Gilabert M, Kavan T, Panasci L, Melnychuk D, Batist G, Kavan P (2016) Clinical practice patterns in chemotherapeutic treatment regimens for metastatic colorectal cancer. Clin Colorectal Cancer 15(2):135–140

    Article  PubMed  Google Scholar 

  6. 6.

    Cremolini C, Loupakis F, Antoniotti C, Lonardi S, Masi G, Salvatore L, Cortesi E, Tomasello G, Spadi R, Zaniboni A, Tonini G, Barone C, Vitello S, Longarini R, Bonetti A, D’Amico M, di Donato S, Granetto C, Boni L, Falcone A (2015) Early tumor shrinkage and depth of response predict long-term outcome in metastatic colorectal cancer patients treated with first-line chemotherapy plus bevacizumab: results from phase III TRIBE trial by the Gruppo Oncologico del Nord Ovest. Ann Oncol 26(6):1188–1194

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Bennouna J, Sastre J, Arnold D, Österlund P, Greil R, van Cutsem E, von Moos R, Viéitez JM, Bouché O, Borg C, Steffens CC, Alonso-Orduña V, Schlichting C, Reyes-Rivera I, Bendahmane B, André T, Kubicka S, ML18147 Study Investigators (2013) Continuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): a randomised phase 3 trial. Lancet Oncol. 14(1):29–37

    Article  CAS  PubMed  Google Scholar 

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Purchase of the Flatiron Health database for the conduct of this research was supported by Eli Lilly and Company.

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Correspondence to Lisa M. Hess.

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All authors were employees of Eli Lilly and Company at the time this work was conceptualized and initiated; DM retired from Eli Lilly and Company prior to submission of this work to the journal.

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Treatment patterns and overall survival outcomes for 14,315 patients diagnosed with colorectal cancer from an electronic medical records database in the USA were studied.

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Hess, L.M., Cui, Z.L., Mytelka, D.S. et al. Treatment patterns and survival outcomes for patients receiving second-line treatment for metastatic colorectal cancer in the USA. Int J Colorectal Dis 34, 581–588 (2019).

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  • Observational study
  • Electronic medical records
  • Rapid progression
  • Colorectal cancer
  • Overall survival
  • Treatment patterns