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Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis

Yin, Jun, Dawood, Shaheenah, Cohen, Romain, Meyers, Jeff, Zalcberg, John, Yoshino, Takayuki, Seymour, Matthew, Maughan, Tim, Saltz, Leonard, Van Cutsem, Eric, Venook, Alan, Schmoll, Hans-Joachim, Goldberg, Richard, Hoff, Paulo, Hecht, J. Randolph, Hurwitz, Herbert, Punt, Cornelis, Diaz Rubio, Eduard, Koopman, Miriam, Cremolini, Chiara, Heinemann, Volker, Tournigard, Christophe, Bokemeyer, Carsten, Fuchs, Charles, Tebbutt, Niall, Souglakos, John, Doulliard, Jean-Yves, Kabbinavar, Fairooz, Chibaudel, Benoist, de Gramont, Aimery, Shi, Qian, Grothey, Axel and Adams, Richard 2021. Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis. Therapeutic Advances in Medical Oncology 13 , pp. 1-11. 10.1177/17588359211020547

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Abstract

Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis Show less Jun Yin*, Shaheenah Dawood*, Romain Cohen, Jeff Meyers, John Zalcberg, Takayuki Yoshino, Matthew Seymour, Tim Maughan, Leonard Saltz, Eric Van Cutsem, Alan Venook, Hans-Joachim Schmoll, Richard Goldberg, Paulo Hoff, J. Randolph Hecht, Herbert Hurwitz, Cornelis Punt, Eduard Diaz Rubio, Miriam Koopman, Chiara Cremolini, Volker Heinemann, Christophe Tournigard, Carsten Bokemeyer, Charles Fuchs, Niall Tebbutt, John Souglakos, Jean-Yves Doulliard, Fairooz Kabbinavar, Benoist Chibaudel, Aimery de Gramont, Qian Shi, Axel Grothey, Richard AdamsFirst Published June 30, 2021 Research Article https://doi.org/10.1177/17588359211020547 Article information Article has an altmetric score of 7 Open AccessCreative Commons Attribution, Non Commercial 4.0 License Article Information Volume: 13 Article first published online: June 30, 2021; Issue published: January 1, 2021 Received: December 29, 2020; Accepted: May 05, 2021 Jun Yin* Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW Rochester, MN 55905, USA Shaheenah Dawood* Mediclinic City Hospital: North Wing, Dubai Health Care City, Dubai UAE Romain Cohen Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA Jeff Meyers Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA John Zalcberg School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia Takayuki Yoshino Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan Matthew Seymour NIHR Clinical Research Network, Leeds, UK Tim Maughan CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK Leonard Saltz Memory Sloan Kettering Cancer Center, New York, NY, USA Eric Van Cutsem Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium Alan Venook Department of Medicine, The University of California San Francisco, San Francisco, CA, USA Hans-Joachim Schmoll Klinik fur Innere Med IV, University Clinic Halle, Saale, Germany Richard Goldberg Department of Oncology, West Virginia University, Morgantown, WV, USA Paulo Hoff Centro de Oncologia de Brasilia do Sirio Libanes: Unidade Lago Sul, Siro Libanes, Brazil J. Randolph Hecht Ronald Reagan UCLA Medical Center, UCLS Medical Center, Santa Monica, CA, USA Herbert Hurwitz Duke Cancer Institute, Duke University, Durham, NC, USA Cornelis Punt Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands Eduard Diaz Rubio Department Oncology, Hospital Clínico San Carlos, Madrid, Spain Miriam Koopman Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands Chiara Cremolini Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy Volker Heinemann Department of Medical Oncology and Comprehensive Cancer Center, University of Munich, Munich, Germany Christophe Tournigard Hopital Henri Mondor, Creteil, France Carsten Bokemeyer Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Charles Fuchs Director of Yale Cancer Center, Boston, MA, USA Niall Tebbutt Sydney Medical School, University of Sydney, Sydney, Australia John Souglakos University of Crete, Heraklion, Greece Jean-Yves Doulliard University of Nantes Medical School, Nantes, France Fairooz Kabbinavar UCLA Medical Center, Santa Monica, CA, USA Benoist Chibaudel Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France Aimery de Gramont Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France Qian Shi Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA Axel Grothey West Cancer Center, Germantown, TN, USA Richard Adams Cardiff University and Velindre Cancer Center, Cardiff, UK Corresponding Author: yin.jun@mayo.edu *Co-first authors. https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). Abstract Background: Benchmarking international cancer survival differences is necessary to evaluate and improve healthcare systems. Our aim was to assess the potential regional differences in outcomes among patients with metastatic colorectal cancer (mCRC) participating in international randomized clinical trials (RCTs). Design: Countries were grouped into 11 regions according to the World Health Organization and the EUROCARE model. Meta-analyses based on individual patient data were used to synthesize data across studies and regions and to conduct comparisons for outcomes in a two-stage random-effects model after adjusting for age, sex, performance status, and time period. We used mCRC patients enrolled in the first-line RCTs from the ARCAD database, which provided enrolling country information. There were 21,509 patients in 27 RCTs included across the 11 regions. Results: Main outcomes were overall survival (OS) and progression-free survival (PFS). Compared with other regions, patients from the United Kingdom (UK) and Ireland were proportionaly over-represented, older, with higher performance status, more frequently male, and more commonly not treated with biological therapies. Cohorts from central Europe and the United States (USA) had significantly longer OS compared with those from UK and Ireland (p = 0.0034 and p < 0.001, respectively), with median difference of 3–4 months. The survival deficits in the UK and Ireland cohorts were, at most, 15% at 1 year. No evidence of a regional disparity was observed for PFS. Among those treated without biological therapies, patients from the UK and Ireland had shorter OS than central Europe patients (p < 0.001). Conclusions: Significant international disparities in the OS of cohorts of mCRC patients enrolled in RCTs were found. Survival of mCRC patients included in RCTs was consistently lower in the UK and Ireland regions than in central Europe, southern Europe, and the USA, potentially attributed to greater overall population representation, delayed diagnosis, and reduced availability of therapies.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/)
Publisher: SAGE Publications
ISSN: 1758-8359
Date of First Compliant Deposit: 31 August 2021
Date of Acceptance: 5 May 2021
Last Modified: 18 Oct 2021 12:29
URI: https://orca.cardiff.ac.uk/id/eprint/143754

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