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. 2024 Dec 6;29(12):e1680-e1691.
doi: 10.1093/oncolo/oyae239.

Is early-onset colorectal cancer an evolving pandemic? Real-world data from a tertiary cancer center

Angelos Angelakas  1 , Thekla Christodoulou  1 , Konstantinos Kamposioras  1 , Jorge Barriuso  1 , Michael Braun  1 , Jurjees Hasan  1 , Kalena Marti  1 , Vivek Misra  2 , Saifee Mullamitha  1 , Mark Saunders  2 , Natalie Cook  3
Affiliations

Is early-onset colorectal cancer an evolving pandemic? Real-world data from a tertiary cancer center

Angelos Angelakas et al. Oncologist. .

Abstract

Background: Early onset Colorectal Cancer (EOCRC), defined as those diagnosed under the age of 50, has been increasing rapidly since 1970. UK data on EOCRC are currently limited and better understanding of the condition is needed.

Materials and methods: A single-center retrospective study of patients with EOCRC treated over 9 years (2013-2021) at a large UK cancer center was performed. Clinicopathological features, risk factors, molecular drivers, treatment, and survival were analyzed.

Results: In total, 203 patients were included. A significant increase in cases was reported from 2018-2019 (n = 33) to 2020-2021 (n = 118). Sporadic EOCRC accounted for 70% of cases and left-sided tumors represented 70.9% (n = 144). Median duration of symptoms was 3 months, while 52.7% of the patients had de-novo metastatic disease. Progression-free survival after first-line chemotherapy was 6 months (95% CI, 4.85-7.15) and median overall survival (OS) was 38 months (95% CI, 32.86-43.14). In the advanced setting, left-sided primary tumors were associated with a median OS benefit of 14 months over right-sided primaries (28 vs 14 months, P = .009). Finally, primary tumor resection was associated with median OS benefit of 21 months compared with in situ tumors (38 vs 17 months, P < .001).

Conclusions: The incidence of EOCRC is increasing, and survival outcomes remain modest. Raising public awareness and lowering the age for colorectal cancer screening are directions that could improve EOCRC clinical outcomes. There is also a need for large prospective studies to improve the understanding of the nature of EOCRC and the best therapeutic approaches.

Keywords: colorectal cancer; early onset; prognosis; real-world data.

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Conflict of interest statement

All authors declare: no support from any organization for the submitted work; Dr N. Cook has received (1) research grants from Roche Pharmaceuticals, (2) consulting fees from Roche Pharmaceuticals and REDX Pharmaceuticals, (3) payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Roche Pharmaceuticals, (4) support for attending meetings and/or travel from Roche Pharmaceuticals, (5) research funding to research team from AstraZeneca, Orion, F. Hoffmann-La Roche Ltd, Taiho, GSK, Novartis, Starpharma, Bayer, Eisai, UCB, RedX Pharmaceuticals, Stemline Therapeutics, LOXO-oncology, Avacta, Boehringer Ingelheim, Merck and Tarveda Therapeutics, (6) been the named investigator at the patent registered by “Cancer Research Technology Ltd,” (7) participated in data safety monitoring board or advisory board at Roche Pharmaceuticals and Cancer Research UK, (8) had the leadership or fiduciary role in CUP Foundation; Dr M. Saunders has received (1) fees for ad-boards, meetings, lectures, and to attend conferences from Amgen, Takeda, MSD, and Servier; Dr M. Braun has received (1) payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Servier, Amgen, BMS, Pierre Fabre, and GSK, (2) support for attending meetings and/or travel from Servier, (3) participated on a data safety monitoring board or advisory board at GSK; Dr K. Marti has received (1) speaker fee from Servier, (2) ESMO registration and accommodation from Servier, (3) participated in a steering committee for trial at Servier; Dr J. Barriuso has received (1) consulting fees from Ellipses pharma, Nutricia and Medicover, (2) payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Rand Spa, AAA, Novartis, Ipsen, and Pfizer, (3) support for attending meetings and/or travel from Nanostring and Rand Spa.

Figures

Figure 1.
Figure 1.
(a) OS comparison between patients with stages II, III, and IV EOCRC, (b) OS comparison between right- and left-sided primary tumors in patients with de-novo stage IV EOCRC, (c) OS comparison between resected and in situ primary tumors in patients with de novo stage IV EOCRC. Abbreviations: EOCRC, Early Onset Colorectal Cancer; OS, overall survival.
See this image and copyright information in PMC

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