A Long-Term and Large-Scale Real-World Study in Taiwan: Efficacy of Target Therapy in Stage IV Colorectal Cancer

Abstract

This study expands the understanding of the role of target therapy in improving survival of patients with mCRC based on real-world study results. These data represent potential survival outcomes of Taiwanese patients with mCRC in clinical practice. CRC is the most commonly diagnosed cancer and the third leading cause of cancer-related death in Taiwan. The aim of this study was to evaluate the efficacy of target therapy in combination with chemotherapy for mCRC in Taiwan. This was a real-world, retrospective, observational study in patients diagnosed with mCRC (N=1583). A total of 792 patients received chemotherapy plus target therapy (anti-EGFR therapy, n=180; anti-VEGF therapy, n=612) and 791 patients who received chemotherapy alone. Overall survival (OS) and progression-free survival (PFS) were examined. For RAS wild-type patients, the median OS (mOS) was 34.3 months in the EGFR L (left-sided colon) group, 27.3 months in the VEGF L group, 18.4 months in VEGF R (right-sided colon) group, and 13.8 months in EGFR R group (P<0.001). Median PFS (mPFS) was 9.8 months in the EGFR L group, 8.9 months in the VEGF L group, 6.8 months in VEGF R group, and 5.8 months in EGFR R group. In patients with a RAS mutation, mOS was 25.4 months in the VEGF L group and 19.4 months in the VEGF R group (P=0.167). Judicious treatment allocation in Taiwanese patients with mCRC can result in an mOS of 34.3 months using cetuximab plus chemotherapy for left-sided tumors. An mOS of 48.5 months can be achieved using cetuximab plus chemotherapy in the neoadjuvant setting in mCRC patients with left-sided tumors. This study expands our understanding of the role of target therapy in improving survival of mCRC patients based on real-world study results.

Keywords: Taiwan; bevacizumab; cetuximab; colorectal cancer; metastatic colorectal cancer; metastectomy; real-world study; target therapy.

Figure 1

(A) Kaplan–Meier estimates of progression-free survival based on target therapy and sidedness in Ras wild type mCRC. (B) Kaplan–Meier estimates of overall survival based on target therapy and sidedness in Ras wild type mCRC. (C) Kaplan–Meier estimates of overall survival with anti-EGFR therapy based on sidedness in Ras wild type mCRC. (D) Kaplan–Meier estimates of overall survival with anti-VEGF therapy based on sidedness in Ras mutation mCRC. (E) Kaplan–Meier estimates of overall survival based on target therapy and Ras mutation status in left-sided mCRC (F) Kaplan–Meier estimates of overall survival based on the sequence of target therapy. (G) Kaplan–Meier estimates of overall survival based on neoadjuvant target therapy and sidedness before metastasectomy.