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Tumor-size responses to first-line is a predictor of overall survival in metastatic colorectal cancer

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusion

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.

Key Points

• 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.

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Abbreviations

CT:

Computed tomography

EGFR:

Epidermal growth factor receptor

ETS:

Early tumor shrinkage

ETSfl :

Early tumor shrinkage at first line (defined at 8 weeks)

fl:

First line

mCRC:

Metastatic colorectal cancer

OS:

Overall survival

PD:

Progressive disease

PDfl :

Progressive disease at first line

PFS:

Progression-free survival

PR:

Partial response

PRfl :

Partial response at first line (without ETSfl: delayed response)

RECIST:

Response evaluation criteria in solid tumors

Sd:

Stable disease

SDfl :

Stable disease at first line

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Lola-Jade Palmieri and Amina Fihri contributed equally to this work.

Authors and Affiliations

  1. Gastroenterology and Digestive Oncology Department, Pitié–Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France

    Lola-Jade Palmieri, Solène Doat, Olivier Dubreuil & Jean-Baptiste Bachet

  2. Sorbonne University, Paris, France

    Lola-Jade Palmieri, Amina Fihri, Solène Doat, Olivier Dubreuil, Gilles Manceau, Mehdi Karoui, Mathilde Wagner, Olivier Lucidarme & Jean-Baptiste Bachet

  3. Radiology Department, Pitié–Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris, 47–83, boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Amina Fihri, Mathilde Wagner & Olivier Lucidarme

  4. Digestive Surgery Department, Pitié–Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France

    Gilles Manceau & Mehdi Karoui

  5. Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, France

    Mathilde Wagner & Olivier Lucidarme

Authors
  1. Lola-Jade Palmieri
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Corresponding author

Correspondence to Olivier Lucidarme.

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The scientific guarantor of this publication is Prof. Olivier Lucidarme.

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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.

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Palmieri, LJ., Fihri, A., Doat, S. et al. Tumor-size responses to first-line is a predictor of overall survival in metastatic colorectal cancer. Eur Radiol 29, 3871–3880 (2019). https://doi.org/10.1007/s00330-018-5967-0

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