Front-line use of FOLFOXIRI plus bevacizumab and subsequent therapies in metastatic colorectal cancer (mCRC).

Authors

Afsaneh Barzi

Afsaneh Barzi

Medical Oncology and Therapeutics, City of Hope/AccessHope, Duarte, CA

Afsaneh Barzi , Orsolya Lunacsek , Federica Pisa , Xiaoyun Pan , Helene Ostojic , Zdravko Vassilev

Organizations

Medical Oncology and Therapeutics, City of Hope/AccessHope, Duarte, CA, Bayer HealthCare Pharmaceuticals, Whippany, NJ, Real World Evidence Oncology, Bayer AG, Berlin, Germany, Real World Evidence Oncology, Bayer HealthCare Pharmaceuticals Inc, Whippany, NJ, Bayer Consumer Care AG, Basel, Switzerland

Research Funding

Bayer

Background: Emerging data shows that the higher incidence of mCRC in younger patients (pts) is accompanied by more aggressive front-line treatment with chemotherapies, such as FOLFOXIRI+bevacizumab (triplet+bev). We explored the use of triplet+bev and subsequent therapies in a representative sample of community practices in the USA. Methods: This was a retrospective study using the nationwide de-identified Flatiron Health Electronic Health Record-derived database from January 1, 2013, to February 28, 2023. The use of triplet+bev and subsequent treatments were analyzed in pts with newly diagnosed mCRC (≥18 years [yrs] of age) by oncologist-defined, rule-based line of treatment (LOT) and age (18–49, 50–64, and ≥65 yrs). Results: Of 24,285 eligible pts, 14%, 37%, and 49% were 18–49, 50–64, and ≥65 yrs at treatment initiation, respectively (Table). Triplet+bev use in any LOT was the most prevalent in the youngest age group (18–49 yrs) at 7% (Table). Two-thirds (67%) received triplet+bev in first line (1L) and 23% in second line (2L), 57% were male, and 34% had a KRAS mutation (23% missing). From 2013 to 2022, triplet+bev use in newly treated pts increased; this trend was more pronounced in pts 18–49 yrs (Table). Among pts not censored before the end of the respective LOT, median duration of 1L and 2L triplet+bev was 25.1 and 21.6 weeks, respectively (Table). For non-censored pts with and without a KRAS mutation, respectively, median duration of triplet+bev was 26.1 vs 23.5 weeks in 1L and 21.6 vs 16.5 weeks in 2L. Most frequently used new agents after 1L triplet+bev included anti-EGFR (panitumumab or cetuximab; 19%), TAS-102 (12%), regorafenib (10%), and capecitabine (3%). Most frequently used new agents after 2L triplet+bev were TAS-102 (21%), anti-EGFR (17%), regorafenib (15%), and pembrolizumab (8%). Conclusions: Our study shows that the use of triplet+bev has increased in pts with mCRC over time, particularly in those <50 yrs. Most frequent subsequent therapies across all pts following 1L and 2L triplet+bev included TAS-102, anti-EGFR, and regorafenib. Future research is needed to identify the optimal treatment strategies after triplet+bev.

Age at Systemic Treatment Initiation (yrs)18–4950–64≥65
Pts with any systemic
treatment, n
3,4358,87011,980
Received triplet+bev
in any LOT, n (%)
240 (7)280 (3)119 (1)
Received triplet+bev in first/second LOT, n (%)169 (5) / 51 (1)191 (2) / 58 (1)65 (1) / 35 (<1)
Pts initiating systemic
treatment in 2013
n=218n=534n=784
Triplet+bev initiated in any/first LOT in 2013, n (%)5 (2) / 3 (1)13 (2) / 8 (1)3 (<1) / 0
Pts initiating systemic
treatment in 2022, n
335810959
Triplet+bev initiated in any/first LOT in 2022, n (%)42 (13) / 35 (10)36 (4) / 29 (4)16 (2) / 14 (1)
Median duration of triplet+bev in first LOT, weeks25.925.119.6
Median duration of triplet+bev in second LOT, weeks24.819.423.1

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Abstract Details

Meeting

2024 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Cancers of the Colon, Rectum, and Anus

Track

Colorectal Cancer,Anal Cancer

Sub Track

Patient-Reported Outcomes and Real-World Evidence

Citation

J Clin Oncol 42, 2024 (suppl 3; abstr 45)

DOI

10.1200/JCO.2024.42.3_suppl.45

Abstract #

45

Poster Bd #

D8

Abstract Disclosures