An initial watch and wait approach is a valid strategy for selected patients with newly diagnosed metastatic colorectal cancer

ABSTRACT

Background

A range of treatments are available for patients with metastatic colorectal cancer (mCRC). An initial period without active treatment, a ‘watch and wait approach’, is variably employed in routine practice; however, there is no data to support this approach.

Patients and methods

We prospectively collected data regarding clinician treatment recommendations for patients with newly diagnosed mCRC in addition to subsequent treatment and outcomes. Follow-up and management was according to standard protocols.

Results

Seven hundred and thirty-six patients (59.1% male, 40.9% female) with mCRC (January 2003–December 2010) were analysed; the median age was 67.9 years (range 26.2–95.5). Three hundred and seventy-seven patients (51.2%) received immediate chemotherapy. For 133 (18.1%), treatment was considered inappropriate. 34 patients (4.6%) declined therapy. For 192 (26.1%), a watch and wait policy was adopted and 168 (87.5%) of these received treatment, at a median of 3.7 months (range 2–35 months) from diagnosis. Compared with patients immediately treated, the number receiving all active chemotherapy agents (30.4 versus 39.3%) was similar and median survival (27 versus 17 months, P = 0.0008) was superior.

Conclusions

Our study demonstrates that a substantial minority of patients underwent an initial watch and wait approach. Ultimately, they received a similar treatment exposure to patients treated immediately and the survival outcomes were not compromised.