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Longitudinal Patterns of Chemotherapy Use in Metastatic Colorectal Cancer

Cancer Center Biostatistics; Division of Medical Oncology, Department of Medicine; and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC

Corresponding author: S. Yousuf Zafar, MD, MHS,Division of Medical Oncology, Department of Medicine, Duke University Medical Center, DUMC Box 3505, Durham, NC 27710; e-mail: yousuf.zafar{at}duke.edu.

Purpose: Patients with metastatic colorectal cancer (mCRC) are increasingly exposed to multiple chemotherapy regimens. Insight into patterns of care in mCRC is crucial to understanding physician and patient decision making.

Methods: Patients with mCRC diagnosed between June 2003 and June 2006 were identified from one academic and nine community oncology practices in the southeastern United States. Demographic, disease, treatment, and toxicity data were abstracted by retrospective medical record review.

Results: After screening 738 medical records, 110 patients were determined eligible. Of these, mean age was 58 years (standard deviation, 12 years), 74% had stage IV disease at diagnosis, 39% were male, 53% were white, 26% were black, and 13% were age 70 years or older. As part of first-line mCRC chemotherapy, 100% of patients received regimens containing fluorouracil (FU), 87% received oxaliplatin (95% CI, 81% to 93%), 12% received irinotecan (95% CI, 6% to 18%), and 74% received bevacizumab (95% CI, 66% to 82%). The proportions of patients receiving subsequent lines of chemotherapy were: second line, 48% (n = 53); third line, 26% (n = 29); fourth line, 14% (n = 15); and fifth line, 5% (n = 5). From first- to third-line therapy, use of oxaliplatin and bevacizumab decreased, whereas irinotecan use increased. Among patients for whom therapy was discontinued, 29% experienced disease progression (PD), and 19% experienced toxicity; for 27%, no reason for discontinuation was documented. Of regimens containing oxaliplatin and irinotecan, 22% (n = 25 of 114) and 34% (n = 20 of 59) were discontinued because of PD, respectively. Of the same regimens, 19% (n = 21 of 114) and 20% (n = 12 of 59) were discontinued because of toxicity, respectively.

Conclusion: FU, oxaliplatin, and bevacizumab were most commonly used in first-line therapy for mCRC, despite data showing equivalency between regimens containing oxaliplatin and irinotecan. Use of oxaliplatin decreased and irinotecan use increased as treatment progressed beyond first-line therapy.

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