Effect of Primary Tumor Side on Survival Outcomes in Untreated Patients With Metastatic Colorectal Cancer When Selective Internal Radiation Therapy Is Added to Chemotherapy

Combined Analysis of Two Randomized Controlled Studies

SIRFLOX and FOXFIRE Global Trial Investigators

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

The primary tumor side is emerging as a prognostic factor for patients with liver metastatic colorectal cancer (mCRC). In a combined analysis of data from 2 randomized studies, the addition of selective internal radiation therapy to first-line chemotherapy in patients with mCRC was associated with statistically and clinically significant overall survival gains for patients with a right-sided primary tumor. Background: The primary tumor side is emerging as a major prognostic factor for patients with metastatic colorectal cancer (mCRC). We examined the survival data from 2 randomized studies to determine whether the outcomes differ between patients with mCRC with right-sided primary (RSP) tumors and those with left-sided primary (LSP) tumors after selective internal radiation therapy (SIRT) plus mFOLFOX6 (folinic acid [leucovorin], 5-fluorouracil, oxaliplatin) chemotherapy, versus chemotherapy alone. Patients and Methods: Separate and combined analyses were performed on the data from the SIRFLOX and FOXFIRE global trials, which compared chemotherapy plus SIRT with chemotherapy alone for patients with mCRC liver metastases. The primary tumor side data were prospectively collected. The principal outcome measure was overall survival (OS) stratified by treatment and primary tumor side. Results: In the combined analysis of all 739 patients enrolled, SIRT had no effect on OS (median OS, 24.3 vs. 24.6 months; hazard ratio [HR], 1.021; P =.810). For the 179 patients (24.2%) with a RSP tumor, OS was improved with the addition of SIRT (median, 22.0 vs. 17.1 months HR, 0.641; P =.008). The addition of SIRT was not associated with a significant difference in OS among the 540 patients with a LSP tumor (median, 24.6 vs. 26.6 months; HR, 1.120; P =.264). A test of treatment interaction by primary tumor side was statistically significant for RSP and SIRT (P =.002). Conclusion: The addition of SIRT for patients with RSP tumors, but not for those with LSP tumors, was associated with a statistically and clinically significant OS gain.

Original languageEnglish (US)
JournalClinical Colorectal Cancer
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Colorectal Neoplasms
Radiotherapy
Drug Therapy
Survival
Neoplasms
oxaliplatin
Leucovorin
Patient Rights
Liver Neoplasms
Fluorouracil
Outcome Assessment (Health Care)
Neoplasm Metastasis
Liver
Therapeutics

Keywords

  • Left-sided primary
  • mCRC
  • Overall survival
  • Right-sided primary
  • SIRT

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

@article{8231dac7f2514405b1451f926cc644c0,
title = "Effect of Primary Tumor Side on Survival Outcomes in Untreated Patients With Metastatic Colorectal Cancer When Selective Internal Radiation Therapy Is Added to Chemotherapy: Combined Analysis of Two Randomized Controlled Studies",
abstract = "The primary tumor side is emerging as a prognostic factor for patients with liver metastatic colorectal cancer (mCRC). In a combined analysis of data from 2 randomized studies, the addition of selective internal radiation therapy to first-line chemotherapy in patients with mCRC was associated with statistically and clinically significant overall survival gains for patients with a right-sided primary tumor. Background: The primary tumor side is emerging as a major prognostic factor for patients with metastatic colorectal cancer (mCRC). We examined the survival data from 2 randomized studies to determine whether the outcomes differ between patients with mCRC with right-sided primary (RSP) tumors and those with left-sided primary (LSP) tumors after selective internal radiation therapy (SIRT) plus mFOLFOX6 (folinic acid [leucovorin], 5-fluorouracil, oxaliplatin) chemotherapy, versus chemotherapy alone. Patients and Methods: Separate and combined analyses were performed on the data from the SIRFLOX and FOXFIRE global trials, which compared chemotherapy plus SIRT with chemotherapy alone for patients with mCRC liver metastases. The primary tumor side data were prospectively collected. The principal outcome measure was overall survival (OS) stratified by treatment and primary tumor side. Results: In the combined analysis of all 739 patients enrolled, SIRT had no effect on OS (median OS, 24.3 vs. 24.6 months; hazard ratio [HR], 1.021; P =.810). For the 179 patients (24.2{\%}) with a RSP tumor, OS was improved with the addition of SIRT (median, 22.0 vs. 17.1 months HR, 0.641; P =.008). The addition of SIRT was not associated with a significant difference in OS among the 540 patients with a LSP tumor (median, 24.6 vs. 26.6 months; HR, 1.120; P =.264). A test of treatment interaction by primary tumor side was statistically significant for RSP and SIRT (P =.002). Conclusion: The addition of SIRT for patients with RSP tumors, but not for those with LSP tumors, was associated with a statistically and clinically significant OS gain.",
keywords = "Left-sided primary, mCRC, Overall survival, Right-sided primary, SIRT",
author = "{SIRFLOX and FOXFIRE Global Trial Investigators} and Peter Gibbs and Volker Heinemann and Sharma, {Navesh K.} and Julien Taieb and Jens Ricke and Marc Peeters and Michael Findlay and Bridget Robinson and Christopher Jackson and Andrew Strickland and Val Gebski and {Van Buskirk}, Mark and Huaqing Zhao and {van Hazel}, Guy and Michael Brown and Matthew Burge and Giuseppe Cardaci and Stephen Clarke and Paul Eliadis and Tom Ferguson and Vinod Ganju and Peter Gibbs and {van Hazel}, Guy and Philip James and Chris Karapetis and Winston Liauw and Gavin Marx and Marco Matos and Louise Nott and Nick Pavlakis and Alex Powell and Timothy Price and David Ransom and Eva Segelov and Jenny Shannon and Nimit Singhal and Andrew Strickland and Euan Walpole and Michel Craninx and Thierry Delaunoit and Am{\'e}lie Deleporte and Michel Ferrante and Karen Geboes and Alain Hendlisz and Koen Hendrickx and {De Man}, Marc and Els Monsaert and Veerle Moons and Marc Peeters and Andreas Kaubisch",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.clcc.2018.06.001",
language = "English (US)",
journal = "Clinical Colorectal Cancer",
issn = "1533-0028",
publisher = "Elsevier",

}

TY - JOUR

T1 - Effect of Primary Tumor Side on Survival Outcomes in Untreated Patients With Metastatic Colorectal Cancer When Selective Internal Radiation Therapy Is Added to Chemotherapy

T2 - Combined Analysis of Two Randomized Controlled Studies

AU - SIRFLOX and FOXFIRE Global Trial Investigators

AU - Gibbs, Peter

AU - Heinemann, Volker

AU - Sharma, Navesh K.

AU - Taieb, Julien

AU - Ricke, Jens

AU - Peeters, Marc

AU - Findlay, Michael

AU - Robinson, Bridget

AU - Jackson, Christopher

AU - Strickland, Andrew

AU - Gebski, Val

AU - Van Buskirk, Mark

AU - Zhao, Huaqing

AU - van Hazel, Guy

AU - Brown, Michael

AU - Burge, Matthew

AU - Cardaci, Giuseppe

AU - Clarke, Stephen

AU - Eliadis, Paul

AU - Ferguson, Tom

AU - Ganju, Vinod

AU - Gibbs, Peter

AU - van Hazel, Guy

AU - James, Philip

AU - Karapetis, Chris

AU - Liauw, Winston

AU - Marx, Gavin

AU - Matos, Marco

AU - Nott, Louise

AU - Pavlakis, Nick

AU - Powell, Alex

AU - Price, Timothy

AU - Ransom, David

AU - Segelov, Eva

AU - Shannon, Jenny

AU - Singhal, Nimit

AU - Strickland, Andrew

AU - Walpole, Euan

AU - Craninx, Michel

AU - Delaunoit, Thierry

AU - Deleporte, Amélie

AU - Ferrante, Michel

AU - Geboes, Karen

AU - Hendlisz, Alain

AU - Hendrickx, Koen

AU - De Man, Marc

AU - Monsaert, Els

AU - Moons, Veerle

AU - Peeters, Marc

AU - Kaubisch, Andreas

PY - 2018/1/1

Y1 - 2018/1/1

N2 - The primary tumor side is emerging as a prognostic factor for patients with liver metastatic colorectal cancer (mCRC). In a combined analysis of data from 2 randomized studies, the addition of selective internal radiation therapy to first-line chemotherapy in patients with mCRC was associated with statistically and clinically significant overall survival gains for patients with a right-sided primary tumor. Background: The primary tumor side is emerging as a major prognostic factor for patients with metastatic colorectal cancer (mCRC). We examined the survival data from 2 randomized studies to determine whether the outcomes differ between patients with mCRC with right-sided primary (RSP) tumors and those with left-sided primary (LSP) tumors after selective internal radiation therapy (SIRT) plus mFOLFOX6 (folinic acid [leucovorin], 5-fluorouracil, oxaliplatin) chemotherapy, versus chemotherapy alone. Patients and Methods: Separate and combined analyses were performed on the data from the SIRFLOX and FOXFIRE global trials, which compared chemotherapy plus SIRT with chemotherapy alone for patients with mCRC liver metastases. The primary tumor side data were prospectively collected. The principal outcome measure was overall survival (OS) stratified by treatment and primary tumor side. Results: In the combined analysis of all 739 patients enrolled, SIRT had no effect on OS (median OS, 24.3 vs. 24.6 months; hazard ratio [HR], 1.021; P =.810). For the 179 patients (24.2%) with a RSP tumor, OS was improved with the addition of SIRT (median, 22.0 vs. 17.1 months HR, 0.641; P =.008). The addition of SIRT was not associated with a significant difference in OS among the 540 patients with a LSP tumor (median, 24.6 vs. 26.6 months; HR, 1.120; P =.264). A test of treatment interaction by primary tumor side was statistically significant for RSP and SIRT (P =.002). Conclusion: The addition of SIRT for patients with RSP tumors, but not for those with LSP tumors, was associated with a statistically and clinically significant OS gain.

AB - The primary tumor side is emerging as a prognostic factor for patients with liver metastatic colorectal cancer (mCRC). In a combined analysis of data from 2 randomized studies, the addition of selective internal radiation therapy to first-line chemotherapy in patients with mCRC was associated with statistically and clinically significant overall survival gains for patients with a right-sided primary tumor. Background: The primary tumor side is emerging as a major prognostic factor for patients with metastatic colorectal cancer (mCRC). We examined the survival data from 2 randomized studies to determine whether the outcomes differ between patients with mCRC with right-sided primary (RSP) tumors and those with left-sided primary (LSP) tumors after selective internal radiation therapy (SIRT) plus mFOLFOX6 (folinic acid [leucovorin], 5-fluorouracil, oxaliplatin) chemotherapy, versus chemotherapy alone. Patients and Methods: Separate and combined analyses were performed on the data from the SIRFLOX and FOXFIRE global trials, which compared chemotherapy plus SIRT with chemotherapy alone for patients with mCRC liver metastases. The primary tumor side data were prospectively collected. The principal outcome measure was overall survival (OS) stratified by treatment and primary tumor side. Results: In the combined analysis of all 739 patients enrolled, SIRT had no effect on OS (median OS, 24.3 vs. 24.6 months; hazard ratio [HR], 1.021; P =.810). For the 179 patients (24.2%) with a RSP tumor, OS was improved with the addition of SIRT (median, 22.0 vs. 17.1 months HR, 0.641; P =.008). The addition of SIRT was not associated with a significant difference in OS among the 540 patients with a LSP tumor (median, 24.6 vs. 26.6 months; HR, 1.120; P =.264). A test of treatment interaction by primary tumor side was statistically significant for RSP and SIRT (P =.002). Conclusion: The addition of SIRT for patients with RSP tumors, but not for those with LSP tumors, was associated with a statistically and clinically significant OS gain.

KW - Left-sided primary

KW - mCRC

KW - Overall survival

KW - Right-sided primary

KW - SIRT

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U2 - 10.1016/j.clcc.2018.06.001

DO - 10.1016/j.clcc.2018.06.001

M3 - Article

JO - Clinical Colorectal Cancer

JF - Clinical Colorectal Cancer

SN - 1533-0028

ER -