NEW YORK (Reuters Health) Jan 03 - Peritoneal carcinomatosis in patients with metastatic colorectal cancer is associated with a poorer prognosis following chemotherapy than other disease manifestations, researchers report in a paper online December 12 in the Journal of Clinical Oncology.
"Patients with peritoneal carcinomatosis have 30% shorter survival as compared with other subtypes of metastatic colorectal cancer," Dr. Jan Franko, who worked on the study, told Reuters Health by email. "That is A LOT worse."
Nevertheless, he added, "systemic chemotherapy is still beneficial for these patients."
Dr. Franko, of Mercy Clinics in Des Moines, Iowa, estimated that of the 20,000 or so metastatic colorectal cancer patients newly diagnosed with or developing carcinomatosis in 2011, about a quarter would develop isolated peritoneal carcinomatosis (pcCRC).
He and his colleagues examined outcomes of such patients enrolled in two prospective randomized trials of chemotherapy compared with patients with other manifestations of metastatic colorectal cancer. In total, nearly 2,000 patients were included.
Both groups were similar overall, but liver metastasis was significantly less common in the pcCRC patients (63% vs. 82%). This was also true of lung cancer (27% vs. 34%).
However, pcCRC patients had shorter median overall survival (12.7 vs. 17.6 months, p<0.001) and progression-free survival (5.8 vs. 7.2 months, p=0.001). This remained the case after adjusting for factors including age, performance status, and liver metastases.
In both groups of patients, infusional fluorouracil, leucovorin, and oxaliplatin was superior to irinotecan, leucovorin, and fluorouracil as first-line treatment.
Given this performance, the team notes that the "choice of systemic chemotherapy should be independent of (the) presence or absence of peritoneal carcinomatosis."
"Molecular and genetic profiling of colorectal cancers," they add, "may establish a gene signature that is predictive of a propensity for peritoneal carcinomatosis colorectal cancer and may lead to selection of alternative adjuvant or advanced disease management strategies" for these patients.
In an accompanying editorial, Dr. Andrea Cercek of Memorial Sloan-Kettering Cancer Center and Dr. Leonard Saltz of Weill Cornell Medical College in New York write that optimal treatment will continue to be a subject of debate.
However, they add, "we could not agree more" that "molecular and genetic profiling may help guide our choice of regional and systemic therapies for CRC in all of its various forms and manifestations in the future."
SOURCE: http://bit.ly/xpXlCc
J Clin Oncol 2011.
"Patients with peritoneal carcinomatosis have 30% shorter survival as compared with other subtypes of metastatic colorectal cancer," Dr. Jan Franko, who worked on the study, told Reuters Health by email. "That is A LOT worse."
Nevertheless, he added, "systemic chemotherapy is still beneficial for these patients."
Dr. Franko, of Mercy Clinics in Des Moines, Iowa, estimated that of the 20,000 or so metastatic colorectal cancer patients newly diagnosed with or developing carcinomatosis in 2011, about a quarter would develop isolated peritoneal carcinomatosis (pcCRC).
He and his colleagues examined outcomes of such patients enrolled in two prospective randomized trials of chemotherapy compared with patients with other manifestations of metastatic colorectal cancer. In total, nearly 2,000 patients were included.
Both groups were similar overall, but liver metastasis was significantly less common in the pcCRC patients (63% vs. 82%). This was also true of lung cancer (27% vs. 34%).
However, pcCRC patients had shorter median overall survival (12.7 vs. 17.6 months, p<0.001) and progression-free survival (5.8 vs. 7.2 months, p=0.001). This remained the case after adjusting for factors including age, performance status, and liver metastases.
In both groups of patients, infusional fluorouracil, leucovorin, and oxaliplatin was superior to irinotecan, leucovorin, and fluorouracil as first-line treatment.
Given this performance, the team notes that the "choice of systemic chemotherapy should be independent of (the) presence or absence of peritoneal carcinomatosis."
"Molecular and genetic profiling of colorectal cancers," they add, "may establish a gene signature that is predictive of a propensity for peritoneal carcinomatosis colorectal cancer and may lead to selection of alternative adjuvant or advanced disease management strategies" for these patients.
In an accompanying editorial, Dr. Andrea Cercek of Memorial Sloan-Kettering Cancer Center and Dr. Leonard Saltz of Weill Cornell Medical College in New York write that optimal treatment will continue to be a subject of debate.
However, they add, "we could not agree more" that "molecular and genetic profiling may help guide our choice of regional and systemic therapies for CRC in all of its various forms and manifestations in the future."
SOURCE: http://bit.ly/xpXlCc
J Clin Oncol 2011.
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