Uutela, A., Osterlund, E., Halonen, P. et al. Resectability, conversion, metastasectomy and outcome according to RAS and BRAF status for metastatic colorectal cancer in the prospective RAXO study. Br J Cancer 127, 686–694 (2022). https://doi.org/10.1038/s41416-022-01858-8
Resectability, conversion, metastasectomy and outcome according to RAS and BRAF status for metastatic colorectal cancer in the prospective RAXO study
|Author:||Uutela, Aki1; Osterlund, Emerik1,2; Halonen, Päivi3;|
1Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
2Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
3Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
4Department of Oncology, Oulu University Hospital, Oulu, Finland
5Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
6Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland
7Department of Oncology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
8Joint Municipal Authority for Health Care and Social Services in Keski-Uusimaa, Home Care Geriatric Clinic and Palliative Care, Hyvinkää, Finland
9Department of Oncology, South Carelia Central Hospital, Lappeenranta, Finland
10Department of Oncology, Central Finland Hospital Nova, Jyväskylä, Finland
11Docrates Cancer Center, Helsinki, Finland
12Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
13Department of Genetics, HUSLAB, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
14Department of Genetics, FIMLAB laboratories, Tampere University Hospital, Tampere, Finland
15Department of Pathology, Turku University Hospital and University of Turku, Turku, Finland
16Department of Pathology, Tampere University Hospital and University of Tampere, Tampere, Finland
17Department of Pathology, Oulu University Hospital and University of Oulu, Oulu, Finland
18Department of Pathology, Central Finland Hospital Nova and Department of Biological and Environmental Science, University of Jyväskylä, Jyväskylä, Finland
19Department of Pathology, HUSLAB, HUS Diagnostic Centre and Applied Tumour Genomics, Research Programs Unit, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
20Department of Oncology/ Oncology-Pathology, Karolinska University Hospital Comprehensive Cancer Center, and Karolinska Institutet, Stockholm, Sweden
|Online Access:||PDF Full Text (PDF, 0.7 MB)|
|Persistent link:|| http://urn.fi/urn:nbn:fi-fe2022123074128
|Publish Date:|| 2022-12-30
Background: Outcomes after metastasectomy for metastatic colorectal cancer (mCRC) vary with RAS and BRAF mutational status, but their effects on resectability and conversion rates have not been extensively studied.
Methods: This substudy of the prospective RAXO trial included 906 patients recruited between 2011 and 2018. We evaluated repeated centralised resectability assessment, conversion/resection rates and overall survival (OS), according to RAS and BRAF status.
Results: Patients included 289 with RAS and BRAF wild-type (RAS and BRAFwt), 529 with RAS mutated (RASmt) and 88 with BRAF mutated (BRAFmt) mCRC. Metastatic prevalence varied between the RAS and BRAFwt/RASmt/BRAFmt groups, for liver (78%/74%/61%), lung (24%/35%/28%) and peritoneal (15%/15%/32%) metastases, respectively. Upfront resectability (32%/29%/15%), conversion (16%/13%/7%) and resection/local ablative therapy (LAT) rates (45%/37%/17%) varied for RASa and BRAFwt/RASmt/BRAFmt, respectively. Median OS for patients treated with resection/LAT (n = 342) was 83/69/30 months, with 5-year OS-rates of 67%/60%/24%, while systemic therapy-only patients (n = 564) had OS of 29/21/15 months with 5-year OS-rates of 11%/6%/2% in RAS and BRAFwt/RASmt/BRAFmt, respectively. Resection/LAT was associated with improved OS in all subgroups.
Conclusions: There were significant differences in resectability, conversion and resection/LAT rates according to RAS and BRAF status. OS was also significantly longer for RAS and BRAFwt versus either mutant. Patients only receiving systemic therapy had poorer long-term survival, with variation according to molecular status.
British journal of cancer
|Pages:||686 - 694|
|Type of Publication:||
A1 Journal article – refereed
|Field of Science:||
This investigator-initiated RAXO-study was supported by Finska Läkaresällskapet (2016, 2018, 2019, 2020, 2021, 2022); Cancer Foundation Finland (2019–2020, 2021, 2022–2023; Relander’s Foundation (2020–2022); the Competitive State Research Financing of the Expert Responsibility Area of Tampere, Helsinki and Turku (2016, 2017, 2018, 2019, 2020, 2021, 2022); Tampere University Hospital Funds (Tukisäätiö 2019, 2020; OOO 2020); and the Research Fund of Helsinki University Hospital (2019, 2020, 2021). The infrastructure with database and study nurses were partly supported by pharmaceutical companies (Amgen unrestricted grant 2012–2020, Eli Lilly 2012–2017, Merck KGaA 2012–2020, Roche Oy 2012–2020, Sanofi 2012–2017 and Servier unrestricted grant 2016–2020). The funders had no role in the study design, analysis, interpretation of the data, decision to publish or writing of this report. Open Access funding provided by University of Helsinki including Helsinki University Central Hospital.
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