Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Use and impact of perioperative chemotherapy in patients with resected colorectal cancer metastases. (#298)

Amy Body 1 , Margaret Lee 1 2 3 4 , Hui-Li Wong 4 5 , Alun Pope 3 , Azim Jalali 2 4 , Jeremy Shapiro 6 , Suzanne Kosmider 2 , Jeanne Tie 2 4 5 , Frances Barnett 7 , Gary Richardson 6 , Desmond Yip 8 , Stephanie Hui-Su Lim 9 , Joe McKendrick 1 , Peter Gibbs 2 4 10 , Rachel Wong 1 3 4
  1. Medical Oncology, Eastern Health, Melbourne, VIC, Australia
  2. Medical Oncology, Western Health, Melbourne, VIC, Australia
  3. Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
  4. Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
  5. Medical Oncology, Peter Macallum Cancer Centre, Melbourne, VIC, Australia
  6. Medical Oncology, Cabrini Hospital, Melbourne, VIC, Australia
  7. Medical Oncology, Northern Health, Melbourne, VIC, Australia
  8. Medical Oncology, The Canberra Hospital, Canberra, ACT, Australia
  9. Medical Oncology, Macarthur Cancer Therapy Centre, Sydney, NSW, Australia
  10. Faculty of Medicine and Health Sciences, University of Melbourne, Melbourne, VIC, Australia

Aims

To describe use of and outcomes from perioperative chemotherapy (p-chemo) in metastatic colorectal cancer (mCRC) patients undergoing resection of liver or lung metastases.

Methods

Patients were identified from the TRACC (Treatment of Recurrent and Advanced Colorectal Cancer) database, a multi-centre registry of mCRC patients. P-chemo was defined as chemotherapy within 12 weeks of surgery (pre-operative, post-operative or both). Kaplan-Meier survival analysis was undertaken.

Results

371 patients were identified. Median age was 64, 169 (45%) had de novo stage IV disease, 96% were ECOG 0-1. 284 (77%) had liver-only and 87 (23%) lung-only metastases. 242 (65%) patients received p-chemo (58 pre-operative alone, 134 post-operative alone, 50 both). 62 (19%) patients also received a biologic agent (47/62 pre-operatively). Median age was 68 and 61 years in no p-chemo and p-chemo groups, respectively. 53% of no p-chemo patients and 23% of p-chemo patients had received prior adjuvant chemotherapy. 58% of the preoperative chemotherapy group were considered to have upfront resectable disease.

P-chemo was associated with improved survival (HR 0.62, 95% CI 0.39-0.99). Compared to no p-chemo, post-operative chemotherapy alone was associated with survival benefit (HR 0.40, 95% CI 0.23-0.69) whilst pre-operative chemotherapy alone was not (HR 1.35, 95% CI 0.76-2.41). Patients who received both pre- and post-operative chemotherapy had a trend towards benefit (HR 0.72, 95% CI 0.40-1.30).

P-chemo improved survival in the liver-only (HR 0.57, 95% CI 0.33-0.98) and lung-only metastases groups (trend only, HR 0.42, 95% CI 0.14-1.25).

Conclusion

In routine care there is a variable approach to the use of p-chemo in patients with resectable liver or lung metastases. P-chemo is associated with improved survival but this analysis is potentially confounded by the impact of patient and disease prognostic factors. A multivariate analysis incorporating disease factors such as number of metastases, molecular status and tumour side is being conducted.