Relative contribution of clinical and molecular features to outcome within low and high risk T and N groups in stage III colon cancer (CC).

Authors

null

Frank A. Sinicrope

Mayo Clinic, Rochester, MN

Frank A. Sinicrope , Lucas J. Huebner , Pierre Laurent-Puig , Thomas C. Smyrk , Josep Tabernero , Enrico Mini , Richard M. Goldberg , Gunnar Folprecht , Aziz Zaanan , Karine Le Malicot , Qian Shi , Steven R Alberts , Julien Taieb

Organizations

Mayo Clinic, Rochester, MN, Paris Descartes University, Paris, France, Mayo Clinic Cancer Center, Rochester, MN, Vall d’Hebron University Hospital and Institute of Oncology, Barcelona, Spain, Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy, West Virginia University Cancer Institute, Morgantown, WV, University Hospital Carl Gustav Carus, Dresden, Germany, Department of Medical Oncology, Saint Antoine Hospital, UPMC University Paris 06, Paris, France, FFCD and INSERM U1231, Dijon, France, Department of Health Science Research, Mayo Clinic, Rochester, MN, Hôpital Européen Georges-Pompidou, Sorbonne Paris Cite/Paris Descartes University, Paris, France

Research Funding

U.S. National Institutes of Health

Background: Duration of adjuvant FOLFOX or CAPOX for stage III CC is being guided by pt stratification into low (T1-3N1) and high (T4 or N2) risk groups based on the IDEA study. We determined the relative contributions of clinical and molecular features for prediction of time-to-recurrence (TTR) and survival after recurrence (SAR) within each risk group. Methods: Stage III CC (N=5,430) from 2 trials of adjuvant FOLFOX ± cetuximab with similar outcome by study arm [NCCTG N0147 (Alliance), PETACC-8] were used. Tumors were analyzed for mismatch repair (dMMR vs pMMR), mutations in KRAS (exon 2) and BRAFV600E. Median pt follow-up was 83.4 months. Relative contributions to predicting outcome were assessed using χ2 (Harrell’s rms) based on multivariable (MV) Cox models. Results: N (50.8%) and T (31.8%) stage were the top two contributors to prediction of TTR which supports risk grouping. High risk (n=2566) vs low risk (n=2774) pts had poorer TTR (HR 2.7, 95% CI, 2.4-3.0) and SAR [HR 1.6 (1.4-1.9)], both p<.0001. TTR: KRAS contributed the most to predicting TTR among high (58.6%) and low (51.1%) risk pts (Table). Contribution of MMR (16%) to predicting TTR was limited to low risk pts. Contribution of BRAFV600E to TTR was nearly 3-fold increased in high vs low risk pts. SAR: BRAFV600E contributed the most to predicting SAR, especially in high vs low risk pts (2-fold increase). Tumor sidedness and performance status (PS) were key contributors to SAR, but not TTR. MV associations: TTR: low risk, KRAS [HR 1.7 (1.4-2.3], MMR [HR 0.55 (.35-.87), gender (M/F) [HR 1.3 (1.0-1.5)], all p<.04]; high risk: BRAF [HR 1.3 (1.1-1.7)], sidedness (R vs L) [HR 1.14 (1.0-1.3)], KRAS [HR 1.4 (1.2-1.6)], all p<.04]. SAR: BRAF, sidedness, PS (all p<.05). Conclusions:KRAS mutation was the strongest predictor of shorter TTR in both risk groups whereas BRAFV600E was the primary driver of SAR, especially in high risk pts. Support: U10CA180821, U10CA180882, U24CA196171; BMS, Pfizer, Sanofi. NCT00079274.

% relative contributions.

Low Risk (T1-3N1)
High Risk (T4 or N2)
TTRSARTTRSAR
BRAF6.7%26.1%18.5%54.5%
KRAS58.62.751.14.9
MMR15.82.01.60.2
Sidedness.0430.78.234.0
Gender11.70.20.91.1
Age0.28.24.10.4
PS7.030.115.57.0

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Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Gastrointestinal (Colorectal) Cancer

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Epidemiology/Outcomes

Citation

J Clin Oncol 37, 2019 (suppl; abstr 3520)

DOI

10.1200/JCO.2019.37.15_suppl.3520

Abstract #

3520

Poster Bd #

12

Abstract Disclosures