title: Clinical Practice Patterns in Chemotherapeutic Treatment Regimens for Metastatic Colorectal Cancer.
abstract: BACKGROUND
  The treatment of patients with metastatic colorectal cancer (mCRC) has evolved during the past 2 decades, and patient survival has increased. Consequently, patients are exposed to more chemotherapeutic agents and regimens. Little is known about therapeutic drug sequencing and the factors influencing these choices.
  
  
  METHODS
  An observational, retrospective medical record review was conducted of patients with newly diagnosed adult mCRC from January 2002 to September 2013 identified in the McGill University-Jewish General Hospital's local tumor registry. All patients presented with mCRC (stage IV) and received ≥ 2 cycles and/or ≥ 28 days of first-line chemotherapy. The patient demographics, CRC characteristics, treatment patterns, and outcomes were recorded. The reason for changing or halting therapy was also reported.
  
  
  RESULTS
  Of the 215 patients who underwent treatment, 74.4% received second-line, 36% third-line, and 16.3% fourth-line treatment. In total, 88% received ≥ 3 classes of cytotoxic chemotherapy and 80% received ≥ 1 biologic agent. The most common first-line treatment was FOLFOX (5-fluorouracil, leucovorin, oxaliplatin) (47.4%) or CAPOX (capecitabine, oxaliplatin) (28.8%), and more than one half received bevacizumab (56%). Among the second- and third-line treatments, FOLFIRI (irinotecan, 5-fluorouracil, leucovorin) was the most common (40.3% and 30.3%, respectively), and bevacizumab was the most frequently used biologic agent (48.1% and 39.2%, respectively). For fourth-line treatment and beyond, most patients participated in clinical trials (45.7%) or received panitumumab monotherapy (31.4%). Across the first 4 therapy lines, disease progression was the primary motive for discontinuation (39.5%, 53.8%, 58.2%, and 37.1%).
  
  
  CONCLUSIONS
  FOLFOX was the most common first-line and FOLFIRI the most common second- and third-line mCRC therapy. Bevacizumab was the most frequently used targeted therapy across all 3 treatment lines. Therapy discontinuation was primarily due to disease progression.
authors.affiliation: Department of Medical Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada.
authors.forename: James
authors.initials: J
authors.lastname: McLean
authors.affiliation: Department of Medical Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada.
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Rho
authors.affiliation: Department of Medical Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada.
authors.forename: Gayathri
authors.initials: G
authors.lastname: Kuruba
authors.affiliation: Department of Medical Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada.
authors.forename: Aline
authors.initials: A
authors.lastname: Mamo
authors.affiliation: Department of Medical Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada.
authors.forename: Marine
authors.initials: M
authors.lastname: Gilabert
authors.affiliation: Department of Medical Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada.
authors.forename: Tomas
authors.initials: T
authors.lastname: Kavan
authors.affiliation: Department of Medical Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada; Department of Oncology, Faulty of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Panasci
authors.affiliation: Department of Medical Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada; Department of Oncology, Faulty of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Melnychuk
authors.affiliation: Department of Medical Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada; Department of Oncology, Faulty of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Gerald
authors.initials: G
authors.lastname: Batist
authors.affiliation: Department of Medical Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada; Department of Oncology, Faulty of Medicine, McGill University, Montreal, QC, Canada. Electronic address: petr.kavan@mcgill.ca.
authors.forename: Petr
authors.initials: P
authors.lastname: Kavan
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Attrition; Biologic; Discontinuation of therapy; Longitudinal; Real world