Treatment (tx) intensity for patient groups by predefined tx aims and clinical characteristics in the management of patients (pts) with metastatic colorectal cancer (MCRC): Findings from TherapyMonitor mCRC 2009 in Germany

1. Treatment (tx) intensity for patient groups by predefined tx aims
and clinical characteristics in the management of patients (pts) with
metastatic colorectal cancer (MCRC): Findings from a population‐
based survey in Germany
Sub‐category:
Colorectal Cancer
Category:
Gastrointestinal (Colorectal) Cancer
Meeting:
2011 ASCO Annual Meeting
Abstract No: e14047
Citation: J Clin Oncol 29: 2011 (suppl; abstr e14047)
Author(s): D. Arnold, L. Kellermann, H. Kröning, C. Goerg, D. Buschmann, H.
Schmoll; University Cancer Center Hamburg, Hamburg, Germany;
OncologyInformationService (OiS), Freiburg, Germany; Gemeinschaftspraxis für
Hämatologie und Onkologie, Magdeburg, Germany; Universit, Dept.
Hematology and Oncology, Marburg, Germany; Schwerpunktpraxis
Hämatologie/Onkologie Bonn, Rheinbach, Germany; University Clinic Halle
(Saale), Halle, Germany

2. Background: According to the German S3 guidelines (Schmiegel et al., 2008),
groups (gr) for suggested tx intensity are defined as based on an outcome‐
oriented algorithm (Schmoll & Sargent, Lancet 2007): Gr 1: pts with resectable
liver mets (CLM), Gr 2: pts with CLM, potentially resectable after conversion tx,
Gr 3a/b: pts with incurable disease, with disease related symptoms or at risk
for rapid deterioration (3a) or without latter conditions (3b), gr 4: elderly or
frail patients. In gr 2 and 3a, intense tx regimes (IT), by triple chemo or with
targeted agents (TA), are recommended, whereas in 3b and 4, sequential tx
starting with single agent or doublet tx are regarded as an option.
Methods: A representative sample of 82 sites was selected with regard to the
distribution of treated prevalence in institutions. Pts. characteristics as well as
treating physicians suggestion for group distribution (according to guidelines),
and tx characteristics were evaluated.
Results: Data include 636 pts with first‐line tx (Q4 ´09): Distribution per gr is:
26% gr 1 (immediate surgery); in pts with upfront systemic tx: 16% gr 2, 12% gr
3a, 20% gr 3b, and 26% gr 4. Pts. in gr 2 were significantly (all <0.05) younger,
had better performance status (PS), lack of comorbidity, had tx decision in non‐
university institutions and kras testing, but no more TA or IT. By contrast to the
intention, IT and TA were given without statist. diff. in all gr., with the highest
number (69% and 64%) in symptomatic pts (gr 3a). In a multivariate cluster
analysis, 3 clusters overall including 89% of pts were determined (all p<0,05). In
the only cluster with significantly higher use of TA, pts were younger (<70 y.), in
better PS (≥80% KI), and asymptomatic (independent whether from tumor or
lack of comorbidity).
Conclusions: In clinical practice, the use of the complex, outcome‐orientated
determination system is not generally accepted. The decision making on tx
intensity is rather based on pts characteristics and institutional factors. This
underlines the need for development of further models.