Long-Term Survivors of Metastatic Colorectal Cancer: A Tertiary Care Centre Experience

Abstract

Background Prognosis of metastatic colorectal cancer (mCRC) is poor and goal of treatment is mainly palliative unless there is limited metastatic disease which is surgically resectable. Here, we report a case series of long-term survivors treated predominantly with chemotherapy.

Methods This is a single-center retrospective analysis of patients of mCRC. Records of metastatic colorectal cancer patients registered at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, between the year 2005 and 2015 were retrieved and reviewed. Inclusion criteria were patients who survived 5 years or more, treated mainly by chemotherapy, with either initial presentation as metastatic disease or those who progressed after initial surgery with or without adjuvant therapy. The details about the patient characteristics, treatment, and outcome were collected. The data were censored on September 30, 2020.

Results Records of 370 mCRC patients were reviewed. Thirty-one patients with all the available details fulfilled the criteria for inclusion in the study. Median age was 53 years (range, 22–74 years). Sixteen were women (51.6%). Twenty-four (77%) were newly diagnosed cases with initial presentation as metastatic disease. Commonest site of primary was on the left (21, 67.6%) followed by right side and transverse colon in 5 patients each. Liver was the most common site of metastasis (n = 18, 58.06%). In metastatic setting, the most common chemotherapy regimen used in the first line was CAPOX (n = 11, 35.48%). Only three patients could undergo metastatectomy. Monoclonal antibodies could be used only in 14 patients. Median overall survival (OS) of this cohort is 81.6 months (95% confidence interval [CI], 69.73–117.9).

Conclusion A small but significant proportion of mCRC patients may achieve and maintain durable responses and long term survival with use of combination of chemotherapy with or without biologics.

Keywords

metastatic colorectal cancer - long-term survivors - chemotherapy - India

• References

• 1 Fact Sheets by Cancer. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed April 27, 2018
• 2 Zacharakis M, Xynos ID, Lazaris A. et al. Predictors of survival in stage IV metastatic colorectal cancer. Anticancer Res 2010; 30 (02) 653-660
• 3 Chow FC-L, Chok KS-H. Colorectal liver metastases: an update on multidisciplinary approach. World J Hepatol 2019; 11 (02) 150-172
• 4 Kemeny NE. Treatment of metastatic colon cancer: “the times they are A-changing”. J Clin Oncol 2013; 31 (16) 1913-1916
• 5 Heinemann V, Douillard JY, Ducreux M, Peeters M. Targeted therapy in metastatic colorectal cancer—an example of personalised medicine in action. Cancer Treat Rev 2013; 39 (06) 592-601
• 6 Perez N, Tournigand C, Mabro M. et al. Long term survival in metastatic colorectal cancer treated with leucovorin and 5-fluoro-uracil chemotherapy. Rev Med Interne 2004; 25 (02) 124-128
• 7 Sanoff HK, Sargent DJ, Campbell ME. et al. Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: N9741. J Clin Oncol 2008; 26 (35) 5721-5727
• 8 Masi G, Loupakis F, Pollina L. et al. Long-term outcome of initially unresectable metastatic colorectal cancer patients treated with 5-fluorouracil/leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) followed by radical surgery of metastases. Ann Surg 2009; 249 (03) 420-425
• 9 Ferrarotto R, Pathak P, Maru D. et al. Durable complete responses in metastatic colorectal cancer treated with chemotherapy alone. Clin Colorectal Cancer 2011; 10 (03) 178-182
• 10 Dy GK, Hobday TJ, Nelson G. et al. Long-term survivors of metastatic colorectal cancer treated with systemic chemotherapy alone: a north central cancer treatment group review of 3811 patients, n0144. Clin Colorectal Cancer 2009; 8 (02) 88-93
• 11 Kopetz S, Chang GJ, Overman MJ. et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol 2009; 27 (22) 3677-3683
• 12 Giacchetti S, Itzhaki M, Gruia G. et al. Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery. Ann Oncol 1999; 10 (06) 663-669
• 13 Dattatreya S. Metastatic colorectal cancer-prolonging overall survival with targeted therapies. South Asian J Cancer 2013; 2 (03) 179-185
• 14 Baran B, Mert Ozupek N, Yerli Tetik N, Acar E, Bekcioglu O, Baskin Y. Difference between left-sided and right-sided colorectal cancer: a focused review of literature. Gastroenterol Res 2018; 11 (04) 264-273
• 15 Holch JW, Ricard I, Stintzing S, Modest DP, Heinemann V. The relevance of primary tumour location in patients with metastatic colorectal cancer: a meta-analysis of first-line clinical trials. Eur J Cancer 2017; 70: 87-98
• 16 Van K Loon, Venook AP. Curable patient with metastatic colorectal cancer: balancing effective therapies and toxicities. J Clin Oncol 2014; 32 (10) 991-996
• 17 Weickhardt A, Wells K, Messersmith W. Oxaliplatin-induced neuropathy in colorectal cancer [e-pub ahead of print]. J Oncol 2011; 2011: 201593
• 18 López-Gómez M, Merino M, Casado E. Long-term treatment of metastatic colorectal cancer with panitumumab. Clin Med Insights Oncol 2012; 6: 125-135