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Khakoo S, Chau I, Pedley I, Ellis R, Steward W, Harrison M, Baijal S, Tahir S, Ross P, Raouf S, Ograbek A, Cunningham D. ACORN: Observational Study of Bevacizumab in Combination With First-Line Chemotherapy for Treatment of Metastatic Colorectal Cancer in the UK. Clin Colorectal Cancer 2019; 18:280-291.e5. [PMID: 31451367 DOI: 10.1016/j.clcc.2019.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/26/2019] [Accepted: 07/07/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Survival in metastatic colorectal cancer is worse than expected in the United Kingdom. Real-world data are needed to better understand UK-specific treatment practices that may explain this. PATIENTS AND METHODS The Avastin ColORectal Non-interventional (ACORN) study is a multicenter, prospective, UK-based, observational, phase 4 study (ClinicalTrials.gov, NCT01506167) that recruited patients with metastatic colorectal cancer scheduled to receive bevacizumab in combination with first-line chemotherapy as part of routine clinical practice. Primary end points included progression-free survival, overall survival (OS), serious adverse events (AEs), and grade 3 to 5 bevacizumab-related AEs. RESULTS A total of 714 patients were recruited between August 30, 2012, and February 4, 2014. Median follow-up was 16.4 months. Median first-line chemotherapy duration was 5.6 months, with capecitabine/oxaliplatin (265 [37.1%]) being the most common regimen. Median total chemotherapy duration was 8.1 months and did not vary by geographic location in the UK. Median progression-free survival (95% confidence interval) was 8.7 (8.2-9.1) months, and median OS was 17.8 (16.1-19.3) months. There was no significant difference in efficacy by chemotherapy regimen administered. Ninety-nine patients (13.9%) received bevacizumab after disease progression. The safety profile of bevacizumab was consistent with previous studies. CONCLUSION ACORN provided evidence that there were no clear differences observed in outcomes between bevacizumab with capecitabine-based chemotherapy and fluorouracil-based regimens, and confirmed the safety profile of bevacizumab in a real-world UK-based population. The lower-than-expected OS is likely due to the short total chemotherapy duration, less frequent use of bevacizumab after disease progression, and higher rates of in-situ primary tumors.
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Affiliation(s)
- Shelize Khakoo
- Department of Medicine, The Royal Marsden Hospital, London & Surrey, UK
| | - Ian Chau
- Department of Medicine, The Royal Marsden Hospital, London & Surrey, UK
| | - Ian Pedley
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Richard Ellis
- Department of Clinical Oncology, Royal Cornwall Hospital, Truro, UK
| | - Will Steward
- Leicester Cancer Research Centre, Leicester Royal Infirmary, Leicester, UK
| | - Mark Harrison
- Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, UK
| | - Shobhit Baijal
- Department of Oncology, Heartlands Hospital, Birmingham, UK
| | | | - Paul Ross
- Department of Oncology, Guy's and St Thomas' Hospital, London, UK
| | | | - Agnes Ograbek
- Medical Affairs, Roche Products Limited, Welwyn Garden City, UK
| | - David Cunningham
- Department of Medicine, The Royal Marsden Hospital, London & Surrey, UK.
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Weller D, Menon U, Zalounina Falborg A, Jensen H, Barisic A, Knudsen AK, Bergin RJ, Brewster DH, Cairnduff V, Gavin AT, Grunfeld E, Harland E, Lambe M, Law RJ, Lin Y, Malmberg M, Turner D, Neal RD, White V, Harrison S, Reguilon I, Vedsted P. Diagnostic routes and time intervals for patients with colorectal cancer in 10 international jurisdictions; findings from a cross-sectional study from the International Cancer Benchmarking Partnership (ICBP). BMJ Open 2018; 8:e023870. [PMID: 30482749 PMCID: PMC6278806 DOI: 10.1136/bmjopen-2018-023870] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE International differences in colorectal cancer (CRC) survival and stage at diagnosis have been reported previously. They may be linked to differences in time intervals and routes to diagnosis. The International Cancer Benchmarking Partnership Module 4 (ICBP M4) reports the first international comparison of routes to diagnosis for patients with CRC and the time intervals from symptom onset until the start of treatment. Data came from patients in 10 jurisdictions across six countries (Canada, the UK, Norway, Sweden, Denmark and Australia). DESIGN Patients with CRC were identified via cancer registries. Data on symptomatic and screened patients were collected; questionnaire data from patients' primary care physicians and specialists, as well as information from treatment records or databases, supplemented patient data from the questionnaires. Routes to diagnosis and the key time intervals were described, as were between-jurisdiction differences in time intervals, using quantile regression. PARTICIPANTS A total of 14 664 eligible patients with CRC diagnosed between 2013 and 2015 were identified, of which 2866 were included in the analyses. PRIMARY AND SECONDARY OUTCOME MEASURES Interval lengths in days (primary), reported patient symptoms (secondary). RESULTS The main route to diagnosis for patients was symptomatic presentation and the most commonly reported symptom was 'bleeding/blood in stool'. The median intervals between jurisdictions ranged from: 21 to 49 days (patient); 0 to 12 days (primary care); 27 to 76 days (diagnostic); and 77 to 168 days (total, from first symptom to treatment start). Including screen-detected cases did not significantly alter the overall results. CONCLUSION ICBP M4 demonstrates important differences in time intervals between 10 jurisdictions internationally. The differences may justify efforts to reduce intervals in some jurisdictions.
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Affiliation(s)
| | - Usha Menon
- MRC Clinical Trials Unit and Instittue of Clinical Trials and Methodology, University College London, London, UK
| | | | - Henry Jensen
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Andriana Barisic
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rebecca J Bergin
- Centre for Behavioral Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - David H Brewster
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
- Scottish Cancer Registry, Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Victoria Cairnduff
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Eva Grunfeld
- Health Services Research Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Elizabeth Harland
- Department of Epidemiology and Cancer Registry, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Mats Lambe
- Regional Cancer Center Uppsala and Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden
| | - Rebecca-Jane Law
- North Wales Centre for Primary Care Research, Bangor Institute for Health and Medical Research, Bangor University, Bangor, UK
| | - Yulan Lin
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Malmberg
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Donna Turner
- Population Oncology, Cancer Care Manitoba, Winnipeg, Canada
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor Institute for Health and Medical Research, Bangor University, Bangor, UK
- Academic Unit of Primary Care, University of Leeds, Leeds, UK
| | - Victoria White
- Centre for Behavioral Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Psychology, Deakin University School of Psychology, Burwood, Victoria, Australia
| | | | | | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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