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

  • Lola-Jade Palmieri
  • Amina Fihri
  • Solène Doat
  • Olivier Dubreuil
  • Gilles Manceau
  • Mehdi Karoui
  • Mathilde Wagner
  • Olivier LucidarmeEmail author
  • Jean-Baptiste Bachet
Oncology
  • 19 Downloads

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.

Keywords

Response evaluation criteria in solid tumors Colonic neoplasms Survival rate Tumor burden 

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

Notes

Funding

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

Compliance with ethical standards

Guarantor

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

Conflict of interest

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.

Informed consent

Written informed consent was not required for this study because it is a retrospective study.

Ethical approval

Institutional Review Board approval was not required because it was a retrospective study.

Methodology

• retrospective

• observational

• performed at one institution

Supplementary material

330_2018_5967_MOESM1_ESM.docx (23 kb)
ESM 1 (DOCX 22 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Lola-Jade Palmieri
    • 1
    • 2
  • Amina Fihri
    • 2
    • 3
  • Solène Doat
    • 1
    • 2
  • Olivier Dubreuil
    • 1
    • 2
  • Gilles Manceau
    • 2
    • 4
  • Mehdi Karoui
    • 2
    • 4
  • Mathilde Wagner
    • 2
    • 3
    • 5
  • Olivier Lucidarme
    • 2
    • 3
    • 5
    Email author
  • Jean-Baptiste Bachet
    • 1
    • 2
  1. 1.Gastroenterology and Digestive Oncology Department, Pitié–Salpêtrière HospitalAssistance Publique–Hôpitaux de ParisParisFrance
  2. 2.Sorbonne UniversityParisFrance
  3. 3.Radiology Department, Pitié–Salpêtrière HospitalAssistance Publique–Hôpitaux de ParisParis Cedex 13France
  4. 4.Digestive Surgery Department, Pitié–Salpêtrière HospitalAssistance Publique–Hôpitaux de ParisParisFrance
  5. 5.Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie BiomédicaleParisFrance

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