Comparison of Folfox and Folfiri Protocols at First-Line Treatment in Patients with Metastatic Colorectal Cancer in Treatment Response and Survival Results According to Primary Tumor Location

Abstract

ABSTRACT Objective: Various factors are involved in the selection of chemotherapy protocols used in the treatment of patients with colorectal cancer. When determining the treatment regimen, we sought to determine the option that would be more effective depending on the region of the colon where the primary tumor is located. Material and Methods: Our study was conducted with the involvement of patients diagnosed with colorectal cancer by biopsy at Akdeniz University Faculty of Medicine Hospital between 01.01.2014 and 30.08.2022. Among these patients, those who had metastatic disease at the time of diagnosis, those who continued the treatment process in this center, and those who were over 18 years of age were included. Patients’ medical records were screened retrospectively. The patients were divided into two groups as right colon (cecum, ascending colon, and hepatic flexure) and left colon (splenic flexure, descending colon, sigmoid, and rectum) according to primary tumor sites. The patients' primary tumor sites, first-line chemotherapy regimens, anti-VEGF or anti-EGFR agents they received in addition to chemotherapy, overall survival, progression-free survival, and treatment responses were studied. Results: A total of 82 patients participated in the study. 69.5% of them were men and 30.5% were women. The average age was found to be 59.6. Tumors located in the right colon, left colon and rectum were detected in 34.1%, 42%, and 23.2%, respectively. When the first-line chemotherapy protocols of the patients were examined, 56.1% (46 patients) used FOLFOX, while 43.9% (36 patients) used FOLFIRI. KRAS/NRAS gene mutation was found to be negative in 61.0% of the patients and positive in 34.1%. When the BRAF gene was examined, data were unavailable for most patients, and 86.2% of the data that could be determined (29 patients) had negative results and 13.8% had positive results. When the location of the primary tumor and the chemotherapy regimens received in the first line were compared, it was observed that there was no statistically significant difference between the patients' overall survival, progression-free survival and treatment responses. Conclusion: Analyzes in our study showed that the location of the primary tumor did not directly affect the choice of first-line chemotherapy regimen in patients diagnosed with metastatic colorectal cancer. In this sense, clinician decision is important in choosing treatment.

Keywords

• Right Colon
• Left Colon
• FOLFOX
• FOLFIRI
• Overall Survival
• Progression-Free Survival
• Treatment Response

Metastatik Kolorektal Kanserli Hastalarda Birinci Basamakta Folfox ve Folfiri Protokollerinin Primer Tümör Yerleşim Yerine Göre Birinci Basamak Tedavi Yanıtı ve Sağkalım Sonuçlarının Karşılaştırılması

Öz

Amaç: Kolorektal kanser hastalarının tedavisinde kullanılan kemoterapi protokollerinin seçiminde birçok farklı faktör yer almaktadır. Tedavi rejimi belirlenirken, primer tümörün bulunduğu kolon bölgesine göre daha etkili olabilecek seçeneğin belirlenmesini amaçladık. Gereç ve Yöntemler: Çalışmamız; 01.01.2014 ile 30.08.2022 tarihleri arasında Akdeniz Üniversitesi Tıp Fakültesi Hastanesinde biyopsi ile kolorektal kanser tanısı alan hastalardan oluşmuştur. Bu hastalardan tanı anında metastatik hastalığa sahip olanlar, tedavi sürecini yine bu merkezde devam etmiş olanlar ve 18 yaşından büyük olanlar dahil edilmiştir. Hastalar retrospektif olarak taranmıştır. Primer tümör bölgelerine göre sağ kolon (çekum, çıkan kolon ve hepatik fleksura) ve sol kolon (splenik fleksura, inen kolon, sigmoid ve rektum) olarak ikiye ayrılmıştır. Hastaların primer tümör bölgeleri, birinci basamakta aldıkları kemoterapi rejimleri, kemoterapiye ek olarak aldıkları anti-VEGF(Vasküler Endotelyal Büyüme Faktörü veya anti-EGFR(Epidermal Büyüme Faktörü Reseptörü) ajanları, genel sağkalımları, progresyonsuz sağkalımları ve tedavi yanıtları incelenmiştir. Bulgular: Çalışmaya toplam 82 hasta katıldı. Bunların %69,’i erkek, %30.5’i kadındı. Yaş ortalaması 59.6 olarak saptandı. Lokasyon olarak sırasıyla sağ kolon, sol kolon ve rektumda bulunan tümörler %34.1, %42 ve %23.2 oranında saptanmıştır. Hastaların birinci basamak kemoterapi protokolleri incelendiğinde %56.1'i (46 hasta) FOLFOX kullanırken, %43.9'u (36 hasta) FOLFIRI kullanmıştır. Hastaların %61.0’unda KRAS/NRAS gen mutasyonu negatif, %34.0’ında ise pozitif saptanmıştır. BRAF geni incelendiğinde, çoğu hastada verilere ulaşılamamış olup saptanabilen verilerin (29 hasta) %86.2’sinde negatif, %13.8'inde pozitif sonuçlar elde edilmiştir. Primer tümörün yerleşim yeri ve birinci basamakta alınan kemoterapi rejimleri karşılaştırıldığında, hastaların genel sağkalım, progresyonsuz sağkalım ve tedavi yanıtları arasında istatistiksel olarak anlamlı fark olmadığı gözlemlendi. Sonuç: Çalışmamızdaki analizler, metastatik kolorektal kanser tanılı hastalarda, ilk sıra kemoterapi rejimi seçiminde primer tümör yerleşim yerinin direkt olarak etkisi olmadığını göstermiştir. Bu anlamda tedavi seçiminde klinisyen kararı önem taşımaktadır.

Anahtar Kelimeler

• Evre IV Kolorektal Kanser
• Sağ Kolon
• Sol Kolon
• FOLFOX
• FOLFIRI
• Genel Sağkalım
• Progresyonsuz Sağkalım
• Tedavi Yanıtı

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