Trial results not typical in metastatic colorectal cancer

NEW YORK (Reuters Health) - Patients with metastatic colorectal cancer (mCRC) enrolled in clinical trials have a better prognosis than do such patients in general, according to Scandinavian researchers.

"Median survival for mCRC patients is considered to be approaching 2 years," lead investigator Dr. Halfdan Sorbye told Reuters Health. However, he added, "our results show that although mCRC patients receiving combination chemotherapy in a trial have a median survival close to 2 years, survival is lower when considering all patients receiving chemotherapy and much lower considering all patients diagnosed with mCRC."

In the October 15th issue of Cancer, Dr. Sorbye of Haukeland University Hospital, Bergen, Norway and colleagues report that they studied 760 patients who were referred for their first oncology evaluation at 3 hospitals.

Palliative chemotherapy was started in 464 of the patients (61%) and 169 (36%) were included in a trial. Most of the patients not enrolled (69%) did not meet eligibility criteria. Reasons included prior adjuvant chemotherapy, poor performance status, cardiovascular comorbidity and presence of another cancer.

For all chemotherapy patients, the median survival was 15.8 months, and after combination chemotherapy, it was 18 months.

However, trial patients who received combination chemotherapy had significantly longer survival than their non-trial counterparts (21.3 versus 15.2 months).

In all 760 patients, the median survival was 10.7 months. In the 244 patients who received only best supportive care due to poor performance status, median survival was only 2.1 months.

"Our results," concluded Dr. Sorbye, "are a reminder that clinical trial patients are a selection from all patients with the disease. The large numbers of mCRC patients not included in clinical trials or not able to receive optimal treatment deserve more attention, and studies that better accept the heterogeneity of mCRC patients are needed."

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