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Comparative Study
. 2020 Dec;19(4):e151-e156.
doi: 10.1016/j.clcc.2020.02.008. Epub 2020 Feb 8.

Systemic Chemotherapy for Metastatic Colitis-Associated Cancer Has a Worse Outcome Than Sporadic Colorectal Cancer: Matched Case Cohort Analysis

Rona Yaeger  1 , Viktoriya Paroder  2 , David D B Bates  2 , Marinela Capanu  3 , Joanne Chou  3 , Laura Tang  4 , Walid Chatila  5 , Nikolaus Schultz  5 , Jonathan Hersch  1 , David Kelsen  6
Affiliations
Comparative Study

Systemic Chemotherapy for Metastatic Colitis-Associated Cancer Has a Worse Outcome Than Sporadic Colorectal Cancer: Matched Case Cohort Analysis

Rona Yaeger et al. Clin Colorectal Cancer. 2020 Dec.

Abstract

Background: Colitis-associated cancers (CAC) are a catastrophic complication of inflammatory bowel disease; at diagnosis, CAC is frequently at an advanced stage. Although the genomic alterations (GA) in CAC are different from sporadic colorectal cancer (CRC), the same systemic therapies are used. We compared clinically relevant outcomes using standard care systemic chemotherapy of stage IV CAC versus a matched patient control cohort of stage IV CRC patients.

Patients and methods: A retrospective matched cohort design was used. Eighteen cases of stage IV CAC (7 ulcerative colitis, 11 Crohn disease) and 18 CRC were identified. GA analysis was available for all patients. Outcome endpoints included response rate and response duration, progression-free survival, and OS.

Results: Although the response rates were similar (CAC 35.7% vs. CRC 57.1%, P = .45), the median duration of response for CAC was significantly shorter (1.4 months, vs. CRC 11.8 months, P = .006). There was no difference in dose density of first-line therapy between cohorts, suggesting that shorter response duration was due to more rapid development of chemotherapy resistance. Median OS was significantly shorter for CAC patients (13 vs. 27.6 months, P = .034). As expected, there was a difference in the spectrum of GA between CAC and CRC cohorts. However, GA associated with poor prognosis (eg, B-Raf) were no more frequent in the CAC cohort.

Conclusion: Clinically meaningful outcomes of duration of response and OS are worse for CAC versus sporadic CRC patients treated with FOLFOX or FOLFIRI as first therapy for metastatic disease.

Keywords: Chemotherapy; Colitis associated cancer; Crohn’s disease and cancer; Genomics alterations analysis; Ulcerative colitis and cancer.

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Conflict of interest statement

There are no conflicts of interest for any of the authors.

Figures

Figure 1.
Figure 1.
Overall Survival – CAC Cases vs CRC Controls
Figure 2:
Figure 2:
Progression Free Survival
Figure 3.
Figure 3.
Matched analysis of Genomics alterations in patients with metastatic disease
See this image and copyright information in PMC

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