Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis

TY - JOUR

T1 - Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis

AU - Yin, Jun

AU - Dawood, Shaheenah

AU - Cohen, Romain

AU - Meyers, Jeff

AU - Zalcberg, John

AU - Yoshino, Takayuki

AU - Seymour, Matthew

AU - Maughan, Tim

AU - Saltz, Leonard

AU - Van Cutsem, Eric

AU - Venook, Alan

AU - Schmoll, Hans-Joachim

AU - Goldberg, Richard

AU - Hoff, Paulo

AU - Hecht, J Randolph

AU - Hurwitz, Herbert

AU - Punt, Cornelis

AU - Diaz Rubio, Eduard

AU - Koopman, Miriam

AU - Cremolini, Chiara

AU - Heinemann, Volker

AU - Tournigard, Christophe

AU - Bokemeyer, Carsten

AU - Fuchs, Charles

AU - Tebbutt, Niall

AU - Souglakos, John

AU - Doulliard, Jean-Yves

AU - Kabbinavar, Fairooz

AU - Chibaudel, Benoist

AU - de Gramont, Aimery

AU - Shi, Qian

AU - Grothey, Axel

AU - Adams, Richard

N1 - © The Author(s), 2021.

PY - 2021

Y1 - 2021

N2 - Background: Benchmarking international cancer survival differences is necessary to evaluate and improve healthcare systems. Our aim was to assess the potential regional differences in outcomes among patients with metastatic colorectal cancer (mCRC) participating in international randomized clinical trials (RCTs).Design: Countries were grouped into 11 regions according to the World Health Organization and the EUROCARE model. Meta-analyses based on individual patient data were used to synthesize data across studies and regions and to conduct comparisons for outcomes in a two-stage random-effects model after adjusting for age, sex, performance status, and time period. We used mCRC patients enrolled in the first-line RCTs from the ARCAD database, which provided enrolling country information. There were 21,509 patients in 27 RCTs included across the 11 regions.Results: Main outcomes were overall survival (OS) and progression-free survival (PFS). Compared with other regions, patients from the United Kingdom (UK) and Ireland were proportionaly over-represented, older, with higher performance status, more frequently male, and more commonly not treated with biological therapies. Cohorts from central Europe and the United States (USA) had significantly longer OS compared with those from UK and Ireland (p = 0.0034 and p < 0.001, respectively), with median difference of 3-4 months. The survival deficits in the UK and Ireland cohorts were, at most, 15% at 1 year. No evidence of a regional disparity was observed for PFS. Among those treated without biological therapies, patients from the UK and Ireland had shorter OS than central Europe patients (p < 0.001).Conclusions: Significant international disparities in the OS of cohorts of mCRC patients enrolled in RCTs were found. Survival of mCRC patients included in RCTs was consistently lower in the UK and Ireland regions than in central Europe, southern Europe, and the USA, potentially attributed to greater overall population representation, delayed diagnosis, and reduced availability of therapies.

AB - Background: Benchmarking international cancer survival differences is necessary to evaluate and improve healthcare systems. Our aim was to assess the potential regional differences in outcomes among patients with metastatic colorectal cancer (mCRC) participating in international randomized clinical trials (RCTs).Design: Countries were grouped into 11 regions according to the World Health Organization and the EUROCARE model. Meta-analyses based on individual patient data were used to synthesize data across studies and regions and to conduct comparisons for outcomes in a two-stage random-effects model after adjusting for age, sex, performance status, and time period. We used mCRC patients enrolled in the first-line RCTs from the ARCAD database, which provided enrolling country information. There were 21,509 patients in 27 RCTs included across the 11 regions.Results: Main outcomes were overall survival (OS) and progression-free survival (PFS). Compared with other regions, patients from the United Kingdom (UK) and Ireland were proportionaly over-represented, older, with higher performance status, more frequently male, and more commonly not treated with biological therapies. Cohorts from central Europe and the United States (USA) had significantly longer OS compared with those from UK and Ireland (p = 0.0034 and p < 0.001, respectively), with median difference of 3-4 months. The survival deficits in the UK and Ireland cohorts were, at most, 15% at 1 year. No evidence of a regional disparity was observed for PFS. Among those treated without biological therapies, patients from the UK and Ireland had shorter OS than central Europe patients (p < 0.001).Conclusions: Significant international disparities in the OS of cohorts of mCRC patients enrolled in RCTs were found. Survival of mCRC patients included in RCTs was consistently lower in the UK and Ireland regions than in central Europe, southern Europe, and the USA, potentially attributed to greater overall population representation, delayed diagnosis, and reduced availability of therapies.

U2 - 10.1177/17588359211020547

DO - 10.1177/17588359211020547

M3 - SCORING: Journal article

C2 - 34262614

VL - 13

SP - 17588359211020547

JO - THER ADV MED ONCOL

JF - THER ADV MED ONCOL

SN - 1758-8340

ER -