Safety and efficacy of bevacizumab and systemic therapy in metastatic colorectal cancer patients with peritoneal disease in the TRACC database. — ASN Events
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Safety and efficacy of bevacizumab and systemic therapy in metastatic colorectal cancer patients with peritoneal disease in the TRACC database. (#18)

Aflah Roohullah 1 , Hui-li Wong 2 3 , Katrin Sjoquist 4 , Kathryn Field 2 , Ben Tran 2 5 , Jeremy Shapiro 6 , Joe McKendrick 3 , Desmond Yip 7 8 , Louise Nott 9 , Peter Gibbs 2 5 10 , Lorraine Chantrill 1 11
  1. Macarthur Cancer Therapy Centre, Campbelltown, NSW, Australia
  2. Royal Melbourne Hospital, Parkville, VIC
  3. Box Hill Hospital, Box Hill
  4. NHMRC Clinical Trials Centre, Camperdown, NSW
  5. Western Hospital, Footscray, VIC
  6. Cabrini Health, Malvern, VIC
  7. The Canberra Hospital, Garran, ACT
  8. ANU Medical School, Australia National University, Canberra, ACT
  9. Royal Hobart Hospital, Hobart, TAS
  10. BioGrid Australia, Melbourne, VIC
  11. Pancreas Cancer Group, The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW

Background:
Patients with peritoneal metastases from metastatic colorectal cancer (mCRC) are considered a poor prognostic group. Systemic chemotherapy and Bevacizumab (BEV) improves outcomes in mCRC, but data on safety and efficacy in patients with predominantly peritoneal disease are limited. We aimed to determine the outcomes of patients with predominantly peritoneal disease in a non-trial setting both with and without BEV.

Methods:
TRACC is a prospective electronic database of newly diagnosed mCRC with data collection ongoing at 14 Australian hospitals. Baseline demographics, treatment and outcomes were extracted for patients with peritoneal metastases.

Results:
Of 844 patients, 148 had peritoneal disease; median follow up was 20 months. There were significant imbalances in baseline characteristics between patients with and without peritoneal metastases: with a higher proportion of patients with poor ECOG (2-4) 29.7% vs 17.7%; colon primary 86.5% vs 68.2%; and a higher proportion with multiple disease sitesin the peritoneal group. A similar proportion received chemotherapy in the peritoneal group 109/148 (73.6%) compared to the non-peritoneal group 503/844 (72.3%). In the peritoneal group 72/109 received BEV. Overall survival was longer in the peritoneal group receiving BEV and chemotherapy 16.1 mths vs 9.0 mths (HR=0.56 95%CI 0.28-0.94 p=0.0312) compared to the chemotherapy group. On univariate analysis the proportional benefit from BEV was similar to the non-peritoneal group. Overall, 13 patients had GI perforation: 2/109 (1.8%) with peritoneal disease and 11/503 (2.2%) without peritoneal disease. BEV use was not associated with increased GI perforation in either group (data not shown)

Conclusion:
In routine clinical practice reflected in this database, clinicians appear comfortable prescribing BEV in the presence of peritoneal disease. The addition of BEV to chemotherapy in these patients appears to be safe, with no apparent excess risk of GI perforation, and is associated with an improved OS. Multivariate analyses are planned.