title: Outcome of patients with metastatic colorectal cancer depends on the primary tumor site (midgut vs. hindgut): analysis of the FIRE1-trial (FuFIRI or mIROX as first-line treatment).
abstract: The aim of this study was to investigate the impact of midgut versus hindgut as the primary tumor site in patients with metastatic colorectal cancer (mCRC) receiving chemotherapy with FuFIRI or mIROX. We analyzed 423 patients from a phase III trial that randomized patients in a 1 : 1 fashion to either FuFIRI or mIROX. The cohort was grouped into midgut (n=82) and hindgut (n=341) primary tumors. The primary tumor site (midgut vs. hindgut) was correlated with parameters of treatment efficacy and survival. Our cohort comprised 82 patients presenting with primary midgut tumors and 341 with primary hindgut tumors. Tumors of midgut origin compared with hindgut origin were associated with inferior outcome. Objective response rate was 37 versus 43% (P=0.34), median progression-free survival was 6.0 versus 8.2 months (P=0.024, hazard ratio: 0.75), and median overall survival was 13.6 versus 21.8 months (P=0.001, hazard ratio: 0.65). Patients with midgut mCRC showed a clear trend toward inferior outcome in both study arms. However, the effect appeared less pronounced in the mIROX arm. Further datasets from large trials with various regimens are required as confirmation.
authors.affiliation: aDepartment of Medicine III, University Hospital Grosshadern bInstitute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich cKlinikum St Marien, Amberg dKlinikum Chemnitz, Chemnitz eOnkologische Praxis Landshut, Landshut fGerman Cancer Consortium (DKTK) gGerman Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Dominik P
authors.initials: DP
authors.lastname: Modest
authors.forename: Christoph
authors.initials: C
authors.lastname: Schulz
authors.forename: Ludwig F
authors.initials: LF
authors.lastname: von Weikersthal
authors.forename: Detlef
authors.initials: D
authors.lastname: Quietzsch
authors.forename: Jobst C
authors.initials: JC
authors.lastname: von Einem
authors.forename: Andreas
authors.initials: A
authors.lastname: Schalhorn
authors.forename: Ursula
authors.initials: U
authors.lastname: Vehling-Kaiser
authors.forename: Rüdiger P
authors.initials: RP
authors.lastname: Laubender
authors.forename: Clemens
authors.initials: C
authors.lastname: Giessen
authors.forename: Sebastian
authors.initials: S
authors.lastname: Stintzing
authors.forename: Volker
authors.initials: V
authors.lastname: Heinemann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D009944:Organoplatinum Compounds; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin