Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis
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Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis. / Yin, Jun; Dawood, Shaheenah; Cohen, Romain; Meyers, Jeff; Zalcberg, John; Yoshino, Takayuki; Seymour, Matthew; Maughan, Tim; Saltz, Leonard; Van Cutsem, Eric; Venook, Alan; Schmoll, Hans-Joachim; Goldberg, Richard; Hoff, Paulo; Hecht, J Randolph; Hurwitz, Herbert; Punt, Cornelis; Diaz Rubio, Eduard; Koopman, Miriam; Cremolini, Chiara; Heinemann, Volker; Tournigard, Christophe; Bokemeyer, Carsten; Fuchs, Charles; Tebbutt, Niall; Souglakos, John; Doulliard, Jean-Yves; Kabbinavar, Fairooz; Chibaudel, Benoist; de Gramont, Aimery; Shi, Qian; Grothey, Axel; Adams, Richard.
In: THER ADV MED ONCOL, Vol. 13, 2021, p. 17588359211020547.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -