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Trends in Use and Perceptions About Triplet Chemotherapy Plus Bevacizumab for Metastatic Colorectal Cancer

2021; American Medical Association; Volume: 4; Issue: 9 Linguagem: Inglês

10.1001/jamanetworkopen.2021.24766

2574-3805

Sietske C. van Nassau, Marinde J. G. Bond, Ilva Scheerman, Jesper van Breeschoten, Rob Kessels, Liselot B. Valkenburg-van Iersel, Henk M.W. Verheul, Tineke E. Buffart, Leonie J. Mekenkamp, V.E.P.P. Lemmens, Miriam Koopman, Guus M. Bol, Mirte Mayke Streppel, Leon van Hout, Maartje Los, Zonne L. M. Hofman, Lonneke W. Kessels, Erica H A Groen, Lieke L H van Huis-Tanja, Felix E. de Jongh, Louise J. M. Alferink, Hans‐Martin Otten, Els J E Wink-van Gestel, Ankie M.T. van der Velden, Dirkje W. Sommeijer, Sadaf Oliai Araghi, Loes M Latten-Jansen, Milou S Keusters, Brigitte C.M. Haberkorn, Arie J. Verschoor, Carolien Haazer, Geert‐Jan Creemers, Nikki F T Henckens, Frank Jeurissen, Karin E M de Nijs, Ronald Hoekstra, Judith J Zwartjens, Mathijs P. Hendriks, Arthur D van Leeuwen, Hester van Cruijssen, P Werner, Wendy E C J Heuts, Peter Nieboer, Natascha A. J. B. Peters, Marly van Cranenbroek, Theo van Voorthuizen, Frederiek Terheggen, Merel Pieters, Mark P.S. Sie, Lieke H. J. Simkens, Julia G L Olislagers, Miriam L. Wumkes, Roel Janssen, Leontine E.A.M.M. Spierings, Esther van Staveren, Iris Kats, Allert H. Vos, Josca J Heier, Edwin A. van Breugel, Jeroen Vincent, Marjan A. Davidis, Teunie Sepers, Johan J. B. Janssen, Berend B O Broeren, Linda M. H. van de Winkel, Sieneke A Hiddink, Annemarie Conijn-Mensink, Stefanie van Lunteren, Annette A. van Zweeden, Magda Vergouwe, Brian M J Scholtes, Serge E. Dohmen, Marcia Ijzer, Jaap de Boer, Kees C J A Punt, Geraldine R. Vink, Patricia A. H. Hamers, Karel C Smit, Maarten A. Huismans, Emerens G E Wensink, Suzanna J. Schraa, Karlijn L. van Rooijen, Jeroen W. G. Derksen, Anne M. May, Koen Zwart, Jeanine M J Roodhart,

Gastric Cancer Management and Outcomes

Importance Triplet chemotherapy with fluorouracil, folinic acid, oxaliplatin, and irinotecan plus bevacizumab (FOLFOXIRI-B) is an effective first-line treatment option for patients with metastatic colorectal cancer (mCRC). However, the degree of implementation of FOLFOXIRI-B in daily practice is unknown. Objectives To evaluate the current adoption rate of FOLFOXIRI-B in patients with mCRC and investigate the perspectives of medical oncologists toward this treatment option. Design, Setting, and Participants This 1-week, multicenter, cross-sectional study in the Netherlands used a flash mob design, which facilitates ultrafast data generation (flash) through the engagement of numerous researchers (mob). During the study week (March 1-5, 2021), patient data were retrieved from electronic health records of 47 hospitals on patients with mCRC who were referred to a medical oncologist between November 1, 2020, and January 31, 2021. Interviews were simultaneously conducted with 101 medical oncologists from 52 hospitals who regularly treat patients with mCRC. Exposure First-line systemic treatment as determined by the treating physician. Main Outcomes and Measures The FOLFOXIRI-B prescription rate was the main outcome. Current practice was compared with prescription rates in 2015 to 2018. Eligibility for treatment with FOLFOXIRI-B was estimated. An exploratory outcome was medical oncologists' reported perspectives on FOLFOXIRI-B. Results A total of 5948 patients in the Netherlands (median age [interquartile range], 66 [57-73] years; 3503 [59%] male; and 3712 [62%] with left-sided or rectal tumor) were treated with first-line systemic therapy for synchronous mCRC. A total of 282 patients with mCRC underwent systemic therapy during the study period (2021). Of these 282 patients, 199 (71%) were treated with intensive first-line therapy other than FOLFOXIRI-B, of whom 184 (65%) were treated with oxaliplatin doublets with or without bevacizumab; 14 (5%) with irinotecan doublets with or without bevacizumab, panitumumab, or cetuximab; and 1 (0.4%) with irinotecan with bevacizumab. Fifty-four patients (19%) were treated with fluoropyrimidine monotherapy with or without bevacizumab, 1 patient (0.4%) with panitumumab monotherapy, and 3 (1%) with immune checkpoint inhibitors. In total, 25 patients (9%; 95% CI, 6%-12%) were treated with first-line FOLFOXIRI-B compared with 142 (2%; 95% CI, 2%-3%) in 2015 to 2018. During the study period, 21 of 157 eligible patients (13.4%) in the Netherlands were treated with FOLFOXIRI-B. A total of 87 medical oncologists (86%) reported discussing FOLFOXIRI-B as a treatment option with eligible patients. A total of 47 of 85 (55%) generally communicated a preference for a chemotherapy doublet to patients. These oncologists reported a significantly lower awareness of guidelines and trial results. Toxic effects were the most reported reason to prefer an alternative regimen. Conclusions and Relevance The findings of this study suggest that FOLFOXIRI-B prescription rates have marginally increased in the last 5 years. Considering that most medical oncologists discuss this treatment option, the prescription rate found in this study was below expectations. Awareness of guidelines and trial data seems to contribute to the discussion of available treatment options by medical oncologists, and the findings of this study suggest a need for repeated and continuing medical education.