The advantage of biological agents in mCRC is color blind
Adding biologics to cytotoxic chemotherapy significantly improved overall survival (OS) in metastatic colorectal cancer (mRCC) compared to chemotherapy alone, and the additional benefit was as apparent in black patients as in black patients. blanks, showed a comparative analysis of the effectiveness of Medicare data.
In the overall cohort of 5,617 patients, the median OS was 17.9 months (95% CI 17.3-18.7) in those who received biochemotherapy compared to 8.3 months (95% CI 9.1 to 9.9) in patients who received chemotherapy alone (P
In 4,542 patients of known race and ethnicity, the additional benefit of biologics, usually given within 3 months of chemotherapy, resulted in a 41% improvement in OS compared to chemotherapy alone (HR 0, 59, 95% CI 0.55-0.64, PJAMA network open.
In addition, the additional use of biologics improved OS also by race, to 17.8 months vs. 9 months for chemotherapy alone in white patients vs. 18.6 vs. 9.9 months, respectively, in white patients. black patients (P
“We report for the first time to date that black patients enjoy a survival advantage (with a 42% improvement in survival) through the addition of biologics to cytotoxic chemotherapy similar to the benefit survival rates found for white patients, ”the researchers wrote.
Nevertheless, caution is in order, they explained: “Such a large database analysis does not replace the low representation of racial and ethnic minority groups in RCTs. [randomized clinical trials]. Until racial and ethnic minority groups are equitably included in RCTs, oncologists can prescribe biologics to mCRC patients with reasonable faith in their early benefit, regardless of race. “
The population-based retrospective cohort study included 5,617 patients diagnosed with mCRC from 2004 to 2011 using the NCI Surveillance, Epidemiology and Outcomes (SEER) database and Medicare.
Of these, 70.7% received a biological agent. Biologic treatment was started within 3 months of chemotherapy in approximately 73% of patients. The median age of the patients was 72 years (interquartile range 68-78), approximately half were female, and the colon was the primary site in 76% of cases.
About 12% of the patients were black; 88% were white; and there was no difference in receiving one, two or more lines of chemotherapy or in receiving biological agents, or in the rates at which black and white patients received biological agents.
“This finding may suggest that given the appropriate medical intervention unhindered by access to care or drug coverage, black patients may experience the same clinical advantage as white patients: thus, the driving force behind the disease. Lower OS in black patients may be the lack of access to high-quality health care, ”wrote Goel and his co-authors.
Limitations of the study, the team said, included the fact that the linked SEER-Medicare database lacks information about the tumor mutation status, as well as the fact that the SEER Medicare population is better insured, easier and more urban than the rest of the country.
The study was funded by a grant from the NIH.
Goel and a co-author said they received grants from NIH while the study was being conducted.