title: Second-line chemotherapy use in metastatic colon cancer varies by disease responsiveness.
abstract: BACKGROUND
  Improved survival of patients with metastatic colorectal cancer (CRC) has been shown to correlate with increased utilization of the 3 active cytotoxic chemotherapeutic agents: 5-fluorouracil (5-FU), irinotecan, and oxaliplatin, usually administered in 2 lines of therapy. However, it is unclear which patient, disease, and treatment characteristics are associated with the utilization of a second-line regimen.
  
  
  METHODS
  We performed a retrospective chart review. Patients with metastatic CRC treated with bevacizumab outside of a clinical trial and any infusional 5-FU/leucovorin (LV) regimen off-protocol (ie, 5-FU/LV/irinotecan [FOLFIRI]/bevacizumab or 5-FU/LV/oxaliplatin [FOLFOX]/bevacizumab) at the University of Texas M. D. Anderson Cancer Center between February 2004 and September 2005 were included. Prespecified characteristics of age, tumor burden, severe toxicity, and front-line regimen efficacy were compared with exploratory analyses of additional patient, disease, and treatment characteristics.
  
  
  RESULTS
  Eighty-seven sequential patients treated with the specified front-line regimens were identified. Seventy-six percent of the eligible patients were treated with a second-line regimen. Despite equal treatment durations, patients with a better response of stable disease were significantly less likely to receive a third cytotoxic agent than patients with a partial response (68% vs. 95%; odds ratio, 8.2; P = .02) due to declining performance status (86%) or patient preference (14%). This was associated with a decreased 2-year overall survival (86% vs. 55%). Neither age, tumor burden, nor development of toxicities were associated with a different utilization of a second-line regimen.
  
  
  CONCLUSIONS
  Failure to obtain a response to initial chemotherapy for metastatic disease appears to be associated with decreased utilization of a second-line regimen.
authors.affiliation: University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Politano
authors.forename: Michael
authors.initials: M
authors.lastname: Overman
authors.forename: Priyanka
authors.initials: P
authors.lastname: Pathak
authors.forename: Romil
authors.initials: R
authors.lastname: Chadha
authors.forename: Katrina
authors.initials: K
authors.lastname: Glover
authors.forename: David Z
authors.initials: DZ
authors.lastname: Chang
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Paulo M
authors.initials: PM
authors.lastname: Hoff
authors.forename: James
authors.initials: J
authors.lastname: Abbruzzese
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
authors.forename: Scott
authors.initials: S
authors.lastname: Kopetz
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003110:Colonic Neoplasms / Q000188:drug therapy*; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000706:statistics & numerical data*; D016896:Treatment Outcome