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. 2021 Aug;12(4):1509-1517.
doi: 10.21037/jgo-20-593.

Influence of first line chemotherapy strategy depending on primary tumor location in metastatic colorectal cancer

Zoé Tharin  1 , Julie Blanc  2 , Ikram Charifi Alaoui  2 , Aurélie Bertaut  2 , Francois Ghiringhelli  1   3   4   5   6
Affiliations

Influence of first line chemotherapy strategy depending on primary tumor location in metastatic colorectal cancer

Zoé Tharin et al. J Gastrointest Oncol. 2021 Aug.

Abstract

Background: Primary tumor location (PTL) is a major prognostic factor in metastatic colorectal cancer (mCRC) with left side which present better prognosis than right sided. Uncertainty exists regarding comparative effectiveness of irinotecan or oxaliplatin doublet in mCRC in function of PTL.

Methods: We conducted a retrospective comparing clinical outcomes from both regimens in function of sidedness. Patients with newly diagnosed mCRC candidates to first-line chemotherapy were selected. Clinical outcomes were assessed and stratified by tumor location (left, right and rectal) and type of treatment.

Results: Overall, 702 patients met the inclusion criteria. Primary colon cancer was right-sided in 248 (35.3%) patients, left-sided in 296 (42.2%) and rectal in 158 (22.5%) patients. Whatever PTL monochemotherapy give poor progression-free survival (PFS) and overall survival (OS). Triplet give better PFS and OS only for rectal cancer. When looking at doublet in first line. Folinic acid, 5FU, and irinotecan (FOLFIRI) give better PFS in rectal cancer [PFS of 21.2 (95% CI: 14.9-NR) versus 12.2 (95% CI: 10.1-13.4) months for the folinic acid, 5FU, and oxaliplatin (FOLFOX) group, P=0.009] and at trend for better PFS in right side tumor [14.9 (95% CI: 8.8-20.8) versus 11.3 (95% CI: 8.4-13.2) months for the FOLFOX group. P=0.0755]. No difference was observed in term of OS.

Conclusions: our results support that either FOLFIRI or FOLFOX regimens give similar efficacy in both left and right metastatic colic cancer. FOLFIRI and FOLFIRINOX regimens might be preferred for metastatic rectal carcinoma.

Keywords: Colorectal cancer (CRC); comparative effectiveness research; prognosis factor; sidedness; tumour sidedness.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jgo-20-593). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Association between PFS, PTL and 1st line of metastatic chemotherapy. (A) Left-sided mCRC; (B) right sided mCRC; (C) rectal metastatic cancer. PFS, progression-free survival; PTL, primary tumor location; mCRC, metastatic colorectal cancer.
Figure 2
Figure 2
Association between PFS, PTL and mono, bi- or trichemotherapy. (A) Left-sided mCRC; (B) right sided mCRC; (C) rectal metastatic cancer. PFS, progression-free survival; PTL, primary tumor location; mCRC, metastatic colorectal cancer.
Figure 3
Figure 3
Association between OS, PTL and 1st line of metastatic chemotherapy. (A) Left-sided mCRC; (B) right sided mCRC; (C) rectal metastatic cancer. OS, overall survival; PTL, primary tumor location; mCRC, metastatic colorectal cancer.
See this image and copyright information in PMC

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