Second-line chemotherapy use in metastatic colon cancer varies by disease responsiveness

Seth Politano, Michael Overman, Priyanka Pathak, Romil Chadha, Katrina Glover, David Z. Chang, Robert A. Wolff, Paulo M. Hoff, James Abbruzzese, Cathy Eng, Scott Kopetz

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Improved survival of patients with metastatic colorectal cancer (CRC) has been shown to correlate with increased utilization of the 3 active cytotoxic chemotherapeutic agents: 5-fluorouracil (5-FU), irinotecan, and oxaliplatin, usually administered in 2 lines of therapy. However, it is unclear which patient, disease, and treatment characteristics are associated with the utilization of a second-line regimen. Patients and Methods: We performed a retrospective chart review. Patients with metastatic CRC treated with bevacizumab outside of a clinical trial and any infusional 5-FU/leucovorin (LV) regimen off-protocol (ie, 5-FU/LV/irinotecan [FOLFIRI]/bevacizumab or 5-FU/LV/oxaliplatin [FOLFOX]/bevacizumab) at the University of Texas M. D.Anderson Cancer Center between February 2004 and September 2005 were included. Prespecified characteristics of age, tumor burden, severe toxicity, and front-line regimen efficacy were compared with exploratory analyses of additional patient, disease, and treatment characteristics. Results: Eighty-seven sequential patients treated with the specified front-line regimens were identified. Seventy-six percent of the eligible patients were treated with a second-line regimen. Despite equal treatment durations, patients with a better response of stable disease were significantly less likely to receive a third cytotoxic agent than patients with a partial response (68% vs. 95%; odds ratio, 8.2; P = .02) due to declining performance status (86%) or patient preference (14%). This was associated with a decreased 2-year overall survival (86% vs. 55%). Neither age, tumor burden, nor development of toxicities were associated with a different utilization of a second-line regimen. Conclusion: Failure to obtain a response to initial chemotherapy for metastatic disease appears to be associated with decreased utilization of a second-line regimen.

Original languageEnglish
Pages (from-to)55-59
Number of pages5
JournalClinical Colorectal Cancer
Issue number1
StatePublished - Jan 2008


  • 5-Fluorouracil
  • Bevacizumab
  • Irinotecan
  • Oxaliplatin

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology


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