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Resectability, conversion, metastasectomy and outcome according to RAS and BRAF status for metastatic colorectal cancer in the prospective RAXO study |
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| Author: | Uutela, Aki1; Osterlund, Emerik1,2; Halonen, Päivi3; |
| Organizations: |
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 |
| Format: | article |
| Version: | published version |
| Access: | open |
| Online Access: | PDF Full Text (PDF, 0.7 MB) |
| Persistent link: | http://urn.fi/urn:nbn:fi-fe2022123074128 |
| Language: | English |
| Published: |
Springer Nature,
2022
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| Publish Date: | 2022-12-30 |
| Description: |
AbstractBackground: 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. see all
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| Series: |
British journal of cancer |
| ISSN: | 0007-0920 |
| ISSN-E: | 1532-1827 |
| ISSN-L: | 0007-0920 |
| Volume: | 127 |
| Issue: | 4 |
| Pages: | 686 - 694 |
| DOI: | 10.1038/s41416-022-01858-8 |
| OADOI: | https://oadoi.org/10.1038/s41416-022-01858-8 |
| Type of Publication: |
A1 Journal article – refereed |
| Field of Science: |
3122 Cancers |
| Subjects: | |
| Funding: |
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. |
| Copyright information: |
© The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. |
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https://creativecommons.org/licenses/by/4.0/ |