Medical Oncology and Therapeutics, City of Hope/AccessHope, Duarte, CA
Afsaneh Barzi , Orsolya Lunacsek , Federica Pisa , Xiaoyun Pan , Helene Ostojic , Zdravko Vassilev
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) | 18–49 | 50–64 | ≥65 |
---|---|---|---|
Pts with any systemic treatment, n | 3,435 | 8,870 | 11,980 |
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=218 | n=534 | n=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 | 335 | 810 | 959 |
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, weeks | 25.9 | 25.1 | 19.6 |
Median duration of triplet+bev in second LOT, weeks | 24.8 | 19.4 | 23.1 |
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