Metastasectomy and BRAF mutation: An analysis of survival outcome in metastatic colorectal cancer.

Authors

null

Thiru Prasanna

University of Canberra, Canberra, ACT, Australia

Thiru Prasanna , Rachel Wong , Timothy Jay Price , Jeremy David Shapiro , Jeanne Tie , Hui-Li Wong , Louise M. Nott , David Roder , Margaret Lee , Suzanne Kosmider , Azim Jalali , Matthew E. Burge , Robert Padbury , Guy Maddern , James Moore , Scott Carruthers , Michael Sorich , Christos Stelios Karapetis , Peter Gibbs , Desmond Yip

Organizations

University of Canberra, Canberra, ACT, Australia, Eastern Health, Monash University, Melbourne, Australia, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia, Department, Melbourne, Australia, Department of Medical Oncology, Western Health, Melbourne, Australia, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia, Menzies Research Institute, Hobart, Australia, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia, Western Health, Melbourne, Australia, Royal Brisbane and Women's Hospital, Brisbane, Australia, Department of Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia, Royal Adelaide Hospital, Adelaide, Australia, The Royal Adelaide, Adelaide, Australia, Flinders University, Adelaide, Australia, Flinders Medical Centre, Flinders University, Adelaide, Australia, Royal Melbourne Hospital, Melbourne, Australia, The Canberra Hospital, Canberra, Australia

Research Funding

Other

Background: Surgical resection of oligometastases improves survival in metastatic colorectal cancer (mCRC). It is unclear whether such benefit is consistently observed for BRAF V600E mutant (MT) and wild type (WT) mCRC. We conducted a retrospective analysis to explore the influence of BRAF mutation status on survival outcomes after metastasectomy. Methods: Data collected from two large prospective population databases in Australia (Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) and South Australian cancer registry). Overall survival (OS) and recurrence free survival (RFS) for BRAF MT and WT mCRC were evaluated by Kaplan-Meier method and compared by log-rank test. Results: 513 patients who had undergone metastasectomy were identified, 6% were BRAF MT. Median age 63. Metastasectomy rate was lower in BRAF MT (13 v 27%). In BRAF WT, 4% underwent resection of metastases (mets) in >1 organ at diagnosis and 5% had 3 or 4 metastasectomies versus none in BRAF MT. Median OS in BRAF MT v WT: 25.7 v 48.5 months (HR 1.95; 1.18-3.22). In a multivariate model adjusting for variables which were significant on univariate analysis, OS differences were not statistically significant. Right primary tumor, intact primary, >1 metastatic sites at diagnosis, non R0 resection, peritoneal mets and synchronous mets were independent predictors of worse OS. Among 364 patients with RFS data there was no difference between BRAF MT and WT (16 v 19 months, p=0.09). Rate of downsizing was higher with triplet chemo than doublet +/- bevacizumab or doublet/EGFR in BRAF WT (50 v 30%) as well as MT (33 v 11%). Conclusions: Median OS was > 2 years in BRAF MT V600E after metastasectomy in this study consistent with an OS benefit. OS did not differ after metastasectomy between BRAF MT and WT in a multivariate model. Presence of BRAF MT should not impact patient selection for metastasectomy.

Patient characteristics.

BRAF MT n=31
(%)
BRAF WT n=483
(%)
p
Resected primary90850.6
Synchronous met57510.5
MSI-H1330.02
Right primary70280.001
Rectal primary10310.001
Liver met at diagnosis40660.005
Lung met at diagnosis13260.19
Peritoneal mets at diagnosis60310.002
Complete resection73760.8
1st metastasectomy
-Liver40620.02
-Lung7170.2
-Peritoneum53240.001

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Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal (Colorectal) Cancer

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer–Advanced Disease

Citation

J Clin Oncol 37, 2019 (suppl; abstr 3531)

DOI

10.1200/JCO.2019.37.15_suppl.3531

Abstract #

3531

Poster Bd #

23

Abstract Disclosures

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