From the Guidelines
The 5-year relative overall survival (OS) for patients with metastatic colorectal cancer (mCRC) is approximately 15%. This statistic is based on the most recent and highest quality study available, which was published in 2023 in the Journal of Clinical Oncology 1.
Factors Influencing Survival
The overall survival rate for patients with mCRC is influenced by several factors, including:
- The extent of metastatic disease
- Tumor biology, such as RAS/BRAF mutation status and microsatellite instability (MSI) status
- Patient performance status
- Ability to tolerate aggressive treatment
Treatment Options
Treatment for mCRC typically involves systemic chemotherapy with regimens like FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) or FOLFIRI (5-fluorouracil, leucovorin, and irinotecan), often combined with targeted biological agents. For example, patients with RAS wild-type tumors may benefit from anti-EGFR antibodies like cetuximab or panitumumab, while those with BRAF mutations might benefit from BRAF inhibitors like encorafenib plus cetuximab 1. Patients with microsatellite instability-high (MSI-H) tumors often respond well to immunotherapy with pembrolizumab or nivolumab.
Surgical Intervention
Surgical resection of limited metastatic disease, particularly liver metastases, can significantly improve survival in selected patients. Regular monitoring with CT scans every 2-3 months during treatment and management of treatment-related side effects are essential to optimize outcomes and maintain quality of life during treatment 1.
Current Guidelines
The European Society for Medical Oncology (ESMO) Guideline provides guidance for the comprehensive management of patients with mCRC, including improvements in diagnosis, staging, and treatment approaches 1. The American Society of Clinical Oncology (ASCO) also provides guidelines for the treatment of mCRC, emphasizing the importance of individualized care and consideration of tumor biology and patient factors 1.
From the FDA Drug Label
The median age was 60 years; 60% were male, 79% were White, 57% had an ECOG performance status of 0,21% had a rectal primary and 28% received prior adjuvant chemotherapy. The addition of bevacizumab improved survival across subgroups defined by age (<65 years, ≥65 years) and sex. Results are presented in Table 6 and Figure 1. Table 6: Efficacy Results in Study AVF2107g Efficacy Parameter Bevacizumab with bolus-IFL (N=402) Placebo with bolus-IFL (N=411) Overall Survival Median, in months 20.3 15.6 Hazard ratio (95% CI) 0.66 (0.54,0.81) p-value a <0. 001
The overall survival rate for patients with metastatic colorectal (colon) cancer treated with bevacizumab is as follows:
- Median overall survival: 20.3 months for patients treated with bevacizumab with bolus-IFL, and 15.6 months for patients treated with placebo with bolus-IFL.
- Hazard ratio: 0.66 (95% CI: 0.54,0.81) indicating a significant improvement in overall survival with bevacizumab treatment.
- Key points:
- Bevacizumab improved survival across subgroups defined by age and sex.
- The study results are based on a double-blind, active-controlled study [AVF2107g (NCT00109070)] in 923 patients with previously untreated mCRC. 2
From the Research
Overall Survival Rate for Patients with Metastatic Colorectal Cancer
- The median survival time for patients with metastatic colorectal cancer has been reported to be around 10.6 months in some studies 3.
- However, other studies have shown that the median survival time can be significantly longer, up to 20.3 months, when patients receive combination therapy with bevacizumab and irinotecan, fluorouracil, and leucovorin 4.
- A review of metastatic colorectal cancer diagnosis and treatment reported that approximately 70% to 75% of patients survive beyond 1 year, 30% to 35% beyond 3 years, and fewer than 20% beyond 5 years from diagnosis 5.
- The use of chemotherapy regimens such as FOLFOX and FOLFIRI has been shown to improve overall survival in patients with metastatic colorectal cancer, with median survival times ranging from 17 to 24 months 6.
- Pretreatment selection of regimen according to genetic analysis has also been shown to improve the efficacy of chemotherapy in the first line treatment of metastatic colorectal cancer, with overall response rates significantly higher in patients who received planned treatment based on genetic analysis 7.
Factors Affecting Survival Rate
- The presence of certain genetic mutations, such as KRAS or NRAS sequence variations, can affect the efficacy of targeted therapies and overall survival 5, 6.
- The use of monoclonal antibodies, such as bevacizumab and cetuximab, has been shown to improve overall survival in some patients with metastatic colorectal cancer, particularly those with wild-type KRAS tumors 4, 6.
- The choice of chemotherapy regimen and the order in which they are administered can also impact overall survival, with some studies suggesting that initial combination therapy may be beneficial in certain cases 6, 7.