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Pretzsch E, Heinemann V, Stintzing S, Bender A, Chen S, Holch JW, Hofmann FO, Ren H, Bösch F, Küchenhoff H, Werner J, Angele MK. EMT-Related Genes Have No Prognostic Relevance in Metastatic Colorectal Cancer as Opposed to Stage II/III: Analysis of the Randomised, Phase III Trial FIRE-3 (AIO KRK 0306; FIRE-3). Cancers (Basel) 2022; 14:cancers14225596. [PMID: 36428688 PMCID: PMC9688410 DOI: 10.3390/cancers14225596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There is no standard treatment after resection of colorectal liver metastases and the role of systemic therapy remains controversial. To avoid over- or undertreatment, proper risk stratification with regard to postoperative treatment strategy is highly needed. We recently demonstrated the prognostic relevance of EMT-related (epithelial-mesenchymal transition) genes in stage II/III CRC. As EMT is a major step in CRC progression, we now aimed to analyse the prognostic relevance of EMT-related genes in stage IV CRC using the study cohort of the FIRE-3 trial, an open-label multi-centre randomised controlled phase III trial of patients with metastatic CRC. METHODS Overall and progression free survival were considered as endpoints (n = 350). To investigate the prognostic relevance of EMT-related genes on either endpoint, we compared predictive performance of different models using clinical data only to models using gene data in addition to clinical data, expecting better predictive performance if EMT-related genes have prognostic value. In addition to baseline models (Kaplan Meier (KM), (regularised) Cox), Random Survival Forest (RSF), and gradient boosted trees (GBT) were fit to the data. Repeated, nested five-fold cross-validation was used for hyperparameter optimisation and performance evaluation. Predictive performance was measured by the integrated Brier score (IBS). RESULTS The baseline KM model showed the best performance (OS: 0.250, PFS: 0.251). None of the other models were able to outperform the KM when using clinical data only according to the IBS scores (OS: 0.253 (Cox), 0.256 (RSF), 0.284 (GBT); PFS: 0.254 (Cox), 0.256 (RSF), 0.276 (GBT)). When adding gene data, performance of GBT improved slightly (OS: 0.262 vs. 0.284; PFS: 0.268 vs. 0.276), however, none of the models performed better than the KM baseline. CONCLUSION Overall, the results suggest that the prognostic relevance of EMT-related genes may be stage-dependent and that EMT-related genes have no prognostic relevance in stage IV CRC.
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Affiliation(s)
- Elise Pretzsch
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, partner site 80336 Munich, Germany
| | - Volker Heinemann
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, partner site 80336 Munich, Germany
- Department of Hematology/Oncology and Comprehensive Cancer Center Munich, LMU University Hospital Munich, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital Munich, 81377 Munich, Germany
| | - Sebastian Stintzing
- Department of Hematology, Oncology, and Cancer Immunology (CCM), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117 Berlin, Germany
| | - Andreas Bender
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, 80539 Munich, Germany
- Munich Center for Machine Learning, LMU Munich, 81377 Munich, Germany
| | - Shuo Chen
- Munich Center for Machine Learning, LMU Munich, 81377 Munich, Germany
| | - Julian Walter Holch
- Department of Hematology/Oncology and Comprehensive Cancer Center Munich, LMU University Hospital Munich, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Felix Oliver Hofmann
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, partner site 80336 Munich, Germany
| | - Haoyu Ren
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany
| | - Florian Bösch
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, 37075 Göttingen, Germany
| | - Helmut Küchenhoff
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, 80539 Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany
| | - Martin Konrad Angele
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany
- Correspondence: ; Tel.: +49-89-44000; Fax: +49-89-440075474
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Valenzuela G, Burotto M, Marcelain K, González-Montero J. Liquid biopsy to detect resistance mutations against anti-epidermal growth factor receptor therapy in metastatic colorectal cancer. World J Gastrointest Oncol 2022; 14:1654-1664. [PMID: 36187383 PMCID: PMC9516650 DOI: 10.4251/wjgo.v14.i9.1654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/19/2022] [Accepted: 08/10/2022] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer (CRC) is a major cause of mortality worldwide, associated with a steadily growing prevalence. Notably, the identification of KRAS, NRAS, and BRAF mutations has markedly improved targeted CRC therapy by affording treatments directed against the epidermal growth factor receptor (EGFR) and other anti-angiogenic therapies. However, the survival benefit conferred by these therapies remains variable and difficult to predict, owing to the high level of molecular heterogeneity among patients with CRC. Although classification into consensus molecular subtypes could optimize response prediction to targeted therapies, the acquisition of resistance mutations to targeted therapy is, in part, responsible for the lack of response in some patients. However, the acquisition of such mutations can induce challenges in clinical practice. The utility of liquid biopsy to detect resistance mutations against anti-EGFR therapy has recently been described. This approach may constitute a new standard in the decision algorithm for targeted CRC therapy.
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Affiliation(s)
- Guillermo Valenzuela
- Department of Basic and Clinical Oncology, University of Chile, Santiago 8380453, Chile
- Department of Internal Medicine, Hospital del Salvador, Santiago 7500922, Chile
| | - Mauricio Burotto
- Department of Oncology, Bradford-Hill Clinical Research Center, Santiago 8420383, Chile
| | - Katherine Marcelain
- Department of Basic and Clinical Oncology, University of Chile, Santiago 8380453, Chile
| | - Jaime González-Montero
- Department of Basic and Clinical Oncology, University of Chile, Santiago 8380453, Chile
- Department of Oncology, Bradford-Hill Clinical Research Center, Santiago 8420383, Chile
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Rashad N, Abdulla M, Farouk M, Elkerm Y, Eid Salem S, Yahia M, Saad AS, Abdel Aziz AH, Refaat G, Awad I, ElNaggar M, Kamal K, Refky B, Abdelkhalek M, Touny A, Kassem L, Shash E, Abdelhay AA, Mahmoud BE, Oualla K, Chraiet N, AwadElkarim H Maki H, Kader YA. Resource Oriented Decision Making for Treatment of Metastatic Colorectal Cancer (mCRC) in a Lower-Middle Income Country: Egyptian Foundation of Medical Sciences (EFMS) Consensus Recommendations 2020. Cancer Manag Res 2022; 14:821-842. [PMID: 35250310 PMCID: PMC8896768 DOI: 10.2147/cmar.s340030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/27/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide and the second cause of cancer related mortality. Treatment options for patients with metastatic CRC (mCRC) expanded during the last two decades, with introduction of new chemotherapeutic and targeted agents. Egypt is a lower middle-income country; Egyptian health care system is fragmented with wide diversity in drug availability and reimbursement policies across different health care providing facilities. We report the results of consensus recommendations for treatment of patients with metastatic colorectal cancer developed by Egyptian Foundation of Medical Sciences (EFMS), aiming to harmonize clinical practice through structured expert consensus-based recommendations consistent with the national status. EFMS recommendations could be utilized in other countries with similar economic status. METHODS EFMS recommendations were developed using a modified Delphi process, with three rounds of voting till the final recommendations were approved. A non-systematic review of literature was conducted before generating the provisional statements. Content experts were asked to vote on some recommendations in two different resource groups (restricted resources and non-restricted resources). External review board of experts from a low income and lower-middle countries voted on the applicability of EFMS recommendations in their countries. RESULTS The current recommendations highlighted the discrepancy in health care between restricted and non-restricted resources with expected survival loss and quality of life deterioration. Access to targeted agents in first line is very limited in governmental institutions, and no access to agents approved for third line in patients who failed oxaliplatin and irinotecan containing regimens for patients treated in restricted resource settings. CONCLUSION Management of mCRC in developing countries is a challenge. The currently available resource-stratified guidelines developed by international cancer societies represent a valuable decision-making tool, adaptation to national status in each country based on healthcare system status is required.
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Affiliation(s)
- Noha Rashad
- Medical Oncology Department, Faculty of Medicine, Suez University, Suez, Egypt
| | - Mohamed Abdulla
- Clinical Oncology and Nuclear Medicine Department, Kasr Al-Aini Medical School, Cairo University, Cairo, Egypt
| | - Mohamed Farouk
- Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasser Elkerm
- Department of Cancer Management and Research, Medical Research Institute Hospital, University of Alexandria, Alexandria, Egypt
| | - Salem Eid Salem
- Department of Medical Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Maha Yahia
- Department of Medical Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Amr S Saad
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Hassan Abdel Aziz
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ghada Refaat
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ibrahim Awad
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Maha ElNaggar
- Clinical Oncology Department, Assiut University Hospital, Assiut, Egypt
| | - Khaled Kamal
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Basel Refky
- Department of Surgical Oncology, Oncology Center Mansoura University, Mansoura, Egypt
| | - Mohamed Abdelkhalek
- Department of Surgical Oncology, Oncology Center Mansoura University, Mansoura, Egypt
| | - Ahmed Touny
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Loay Kassem
- Clinical Oncology and Nuclear Medicine Department, Kasr Al-Aini Medical School, Cairo University, Cairo, Egypt
| | - Emad Shash
- Department of Medical Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | | | | | - Karima Oualla
- Medical Oncology Department, Hassan II University Hospital Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - Nesrine Chraiet
- Medical Oncology Department, Salah Azaiez National Cancer Institute, Tunis, Tunisia
| | | | - Yasser Abdel Kader
- Clinical Oncology and Nuclear Medicine Department, Kasr Al-Aini Medical School, Cairo University, Cairo, Egypt
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