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Inclusion of targeted therapies in the standard of care for metastatic colorectal cancer patients in a German cancer center: the more the better?!

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

Significant prolongation of overall survival (OS) has been reached in metastatic colorectal cancer (mCRC) treatment within the last 5–10 years. Our study was conducted in order to evaluate and compare OS of different standard of care treatment options in a university-based outpatient clinic.

Methods

One hundred and three mCRC patients were identified by retrospective analysis and treated according to available guidelines. OS was analyzed according to the different combinations of first- and second-line treatments.

Results

mCRC patients revealed an mOS of 34.4 months. Patients receiving anti-vascular endothelial growth factor (VEGF) blockade in at least one treatment line showed a significantly longer survival time (p = 0.0056) versus patients without any bevacizumab. No OS differences were detected comparing the different first- and second-line chemotherapy (CTX) strategies in the unselected population. However, wild-type (wt) Kras patients treated with anti-epidermal growth factor receptor (EGFR) therapy plus CTX in first-line therapy showed significantly longer OS compared to those receiving only additional VEGF inhibition or no targeted therapy (p = 0.0056; mOS 46.8 vs. 20.4 months, respectively). wt Kras patients profited in trend (p = 0.076) from CTX combinations of first-line anti-EGFR followed by second-line anti-VEGF compared to first-line anti-VEGF followed by second-line anti-EGFR (mOS 46.8 vs. 19.2 months, respectively).

Conclusions

Our results indicate successful allocation of the current mCRC treatment according to the Kras status. Differences in OS of wt Kras patients indicated the further need for randomized trials to define the potential benefit of sequential therapy with EGFR inhibition in first-line therapy followed by VEGFR inhibition vice versa.

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Abbreviations

OS:

Overall survival

mCRC:

Metastatic colorectal cancer

CTX:

Chemotherapy

VEGF:

Vascular endothelial growth factor

EGFR:

Epidermal growth factor receptor

TK:

Tyrosine kinases

TTFS:

Time to failure of strategy

DCR:

Disease control rate

CR:

Complete response

PR:

Partial response

SD:

Stable disease

USE:

Undesirable side effects

PD:

Progressive disease

wt:

Wild type

EOT:

End of treatment

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Acknowledgments

The authors are grateful to all investigators and patients who participated in the trial. We thank Arno Schad for technical assistance and the excellent collaboration. The manuscript was reviewed by all authors.

Conflict of interest

M Moehler received honoraria for presentations in satellite symposia by Merck and Roche. The rest of the authors have no competing interests to declare. Medical writing by GSOmbH (ALK and JMW) was supported by an unrestricted grant of Merck Serono. However, ALK and JMW did not prepare the first draft and did not contribute to critical revisions, interpretation of results, or any critical intellectual impact.

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Authors and Affiliations

  1. 1st Medical Department, Johannes-Gutenberg University of Mainz, Langenbeckstr.1, 55131, Mainz, Germany

    Markus Moehler, Thomas Thomaidis, Chourouk Zeifri, Tareq Barhoom, Jens Marquardt, Philippe Ploch, Joern Schattenberg, Annett Maderer, Arndt Weinmann, Marcus Alexander Woerns & Peter Robert Galle

  2. Medical Clinic, Marienhospital, Darmstadt, Germany

    Carl Christoph Schimanski

  3. GSO mbH, Hamburg, Germany

    Anne L. Kranich & Jens M. Warnecke

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  1. Markus Moehler
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  2. Thomas Thomaidis
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  14. Peter Robert Galle
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Corresponding author

Correspondence to Markus Moehler.

Additional information

Markus Moehler and Thomas Thomaidis have contributed equally to the manuscript.

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Moehler, M., Thomaidis, T., Zeifri, C. et al. Inclusion of targeted therapies in the standard of care for metastatic colorectal cancer patients in a German cancer center: the more the better?!. J Cancer Res Clin Oncol 141, 515–522 (2015). https://doi.org/10.1007/s00432-014-1829-6

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  • DOI: https://doi.org/10.1007/s00432-014-1829-6

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