Metastasectomy and BRAF mutation; an analysis of survival outcome in metastatic colorectal cancer
Section snippets
Background
Metastasectomy increases the survival of patients with oligometastatic colorectal cancer. The 5-year survival rate in multiple surgical series after hepatic metastasectomy ranges from 27% to 58%.1,2 Advances in surgical techniques and systemic therapies have improved the outcomes in the last two decades.3 Even those who present with synchronous metastases, may be considered for curative combined resection at the same time or as a two staged procedure in conjunction with perioperative
Methods
This is a retrospective study of two different datasets extracted from two large Australian cancer registries. The South Australian Cancer Registry19 is a state-wide population based registry which captures all incident cases, while the “Treatment of Recurrent and Advanced Colorectal Cancer” (TRACC) registry20 is a federated national database with data collected from participating cancer centers in the Australian Capital Territory, Victoria and Tasmania. The latter includes patients referred to
Results
Out of 7534 patients screened, a total of 513 patients who had undergone metastasectomy were identified. Median age was 63 and 58% were male. Six percent were BRAF MT (see Table 1). Site of primary CRC was strongly correlated with mutational status (P = <0.001), BRAF MT tumors were most prevalent in right side cancers, consistent with the literature. More than 50% of patients received perioperative chemotherapy. Four percent underwent metastasectomy at more than 1 organ site at diagnosis in
Discussion
The presence of BRAF MT in metastatic CRC confers a poor prognosis, with lower responses to combination systemic anticancer therapies including EGFR inhibitors. The TRIBE study utilized a four-drug combination in the first-line setting which showed improved survival in BRAF MT cohort, however, median OS was still only 13 months in BRAF MT cohort.9 A combination of three RAS pathway protein (BRAF, MEK, EGFR) inhibitors were used to treat BRAF MT mCRC patients in BEACON trial. Though survival
Authors’ Contribution
TP, DY, CK, and PG: conceptualization. MS and TP: formal analysis. TP: writing-original draft. All other authors listed have made substantial, direct, and intellectual contribution in data curation, methodology, writing-review, and editing. All authors have viewed the final manuscript and agreed for submission.
Acknowledgment
Roche Products Pty Limited has provided financial assistance for the development, installation, and maintenance of the BioGrid-TRACC registry. The South Australian State Government has provided support for the maintenance of the SA Metastatic Colorectal Cancer Registry.
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Cited by (0)
Conflicts of Interest: PG has disclosed honoraria from Amgen and Merck. DY has indicated grants from Ipsen, Novartis, Roche. ML has indicated honoraria from Amgen and Merck. All other authors have indicated no conflicts of interest.