Factors associated with long-term survival in patients with early-onset and standard-onset colorectal cancer

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Background: Differences in incidence, clinical features, and survival between early-onset (EO) and standard-onset (SO) colorectal cancer (CRC) are well-established. Factors associated with longer survival have not been reported. We aim to determine clinical and treatment factors associated with longer survival in patients (pts) with metastatic EO and SO CRC. Methods: Pts with metastatic CRC diagnosed between 2010-2019 at two NYC hospitals were identified by tumor registry and classified as EO (diagnosis at < 50 years) or SO (diagnosis at ≥ 50 years). Median overall survival (OS) was calculated for each group using Kaplan Meier curves. Long-term survival was defined as OS > 2 years (EO-CTC median OS). Data was collected by chart review and compared between short vs long-term survivors in EO and SO CRC pts independently. Stata v15 was used for statistical analysis. Results: Of 646 pts, 144 (22.3%) had EO and 502 (77.7%) had SO. High grade tumors were more likely in EO (33.3% vs 24%, OR: 1.59, p = 0.04) than SO; whereas no differences were seen in gender, sidedness, KRAS mutation or chemotherapy. Biologics were used more frequently in EO than SO (OR = 1.7; p = 0.008]. Median OS was 2.1 and 1.9 years in EO and SO. There were 53 (36.8%) and 175 (35.1%) long-term survivors in EO and SO groups. In pts with SO, metastasectomy, irinotecan-based chemotherapy and use of biologics were significantly associated with long-term survival, whereas metastasectomy was the only associated factor in pts with EO. Conclusions: Metastatectomy was the only factor associated with longer survival in both EO and SO groups. Other clinical/pathological and treatment-related factors associated with long-term survival among SO-CRC were not associated with long-term survival among EO-CRC patients. [Table: see text]

Racial ethnic disparities in clinical/pathological features, treatment, and survival among patients with early-onset colorectal cancer

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Background: Globally, the incidence of early-onset colorectal cancer has risen. Racial disparities in colorectal cancer (CRC) are well-described, however data in EO by race/ethnicity is lacking. We aim to compare the presenting features, treatment, and survival features of patients with metastatic early-onset CRC (EO). Methods: Patients with metastatic CRC diagnosed between 2010-2019 at two NYC hospitals were identified by tumor registry (n = 646). Clinical/pathological features, treatment and survival data was collected by chart review and compared between Non-Hispanic Whites (NHW), Non-Hispanic Blacks (NHB) and Hispanics (H) using Chi-square or Fisher’s exact test. Kaplan Meier curves were plotted to compare overall survival (OS) among groups. Stata v15 was used for statistical analysis. Results: Of 646 CRC patients, 126 (21.5%) were NHW, NHB or H diagnosed with EO with a frequency ranging from 16.6% in NHW to 26.1% in H. Non statistically significant lower frequencies of male gender, low/moderate grade, left-sided tumors,and higher frequency of KRAS mutations were seen in NHB (Table). Metastectomy was performed in 20 patients (13.9%) and did not differ between groups. There was no difference in the use of chemotherapy or biologics in general (Table), but NHW were more likely to get cetuximab than NHB (OR:4.5, p = 0.02) and H (OR:4.7, p = 0.02).There were no differences in median OS (1.8 vs. 2.2 vs. 2 years, p = 0.9)or 1-year OS (72% vs 72.3% vs 70.8%) in NHW, NHB and H, respectively. A lower 5-year OS was seen in NBH (14.5%) and Hispanics (24.4%) compared to NHW (44%). Conclusions: EO-CRC is more frequently seen in minority racial/ethnic groups. Despite no differences in the use of chemotherapy or biologic treatment in general, NHB have a lower 5-year survival rate compared to NHW and H. [Table: see text]

The impact of biologic agents in patients with metastatic colorectal cancer by race/ethnicity

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Background: Biologic agents have shown to improve overall survival (OS) in patients with metastatic colorectal cancer (mCRC). However, minority racial/ethnic groups were underrepresented in clinical trials. A retrospective study in a racially-diverse population diagnosed between 2000 - 2011, done by our group, reported a survival benefit with biologics; but, a subgroup analysis suggested that it was restricted to Non-Hispanic whites (NHW) only. This study aims to compare OS in patients with mCRC treated with chemotherapy and biologic agents (CBT) among racial/ethnic groups. Methods: Patients diagnosed with mCRC between 2012-2018 and treated with CBT at 3 cancer centers in the Bronx, NY were identified. Clinical data was collected by retrospective review for demographics (age at metastasis, gender and race/ethnicity categorized as Non-hispanic Black (NHB), NHW or Hispanic), pathological/ treatment characteristics (tumor grade, primary location, chemotherapy regimen, biologic agent). Cases without available race/ethnicity were excluded. OS was measured as time from mCRC diagnosis to death (verified from the National Death Index) and was compared among racial/ethnic groups using Kaplan-Meier curves. Results: A total of 278 patients; of whom 84 (42.4%) were Hispanic, 70 (35.4%) NHB and 44 (22.2%) NHW were included. The median age at diagnosis was 60 years and did not differ among racial/ethnic groups (62.5 vs 55.5 vs 56 years, p=0.07). There was a female predominance in NHB and Hispanics. Bevacizumab was more frequently used in Hispanics and NHB compared to NHW (95.2% vs. 92.9% vs. 77.3%, p=0.003, respectively). There were no differences in the frequency of cetuximab and panitumumab use. Median OS did not differ by racial/ethnic groups (21 in NHW vs. 22.8 in Hispanics and 28.6 months in NHB, p=0.40). Conclusions: Minority groups attain a similar survival benefit from the addition of biologics compared to NHW. Population-based studies are required to confirm these results.

Clinical characteristics and outcomes of patients with advanced hepatocellular carcinoma treated with immunotherapy: A real-world retrospective study

557

Background: Advanced HCC is an aggressive malignancy with dismal prognosis. Newer agents, including immunotherapy (IT), have been granted accelerated approval. Information outside clinical trials is scarce. This study is aimed to describe the clinical characteristics and outcomes of HCC patients treated with IT. Methods: Patients with HCC treated with IT were identified using the institutional data-mining software, Clinical Looking Glass. Patient demographics, clinical, and treatment characteristics were collected. Progression-free survival (PFS) was defined as time from treatment initiation to disease progression or death, and overall-survival (OS) as time from diagnosis of advanced disease to death. PFS and OS were plotted using Kaplan-Meier curves. Results: A total of 52 patients; median age 64 years; male predominance (38, 73.1%) were identified. There were 24 (54.5%) Hispanics, 9 (20.5%) Non-Hispanic Blacks, 7 (15.9%) Non-Hispanic White and 4 (9.1%) Asians. Cirrhosis was seen in 41 (83.7%), and median MELD score was 8 (IQ: 7-10). Hepatitis B and C infection were encountered in 12 (24.5%) and 22 (44%) patients, respectively. Imaging evidence of intravascular invasion was seen in 16 (34.8%) and extrahepatic metastases in 7 (14.9%) cases. Local treatment was provided to 29 (59.2%) and radiation treatment to 14 (28.6%) patients. Nivolumab was used in all the cases, as first-line treatment in 17 (32.7%) and as ≥ second line in 35(67.3%). The median PFS was 6.2 (3.1-10.6) months and was similar in first-line and ≥ second line treatment (8 vs 5.9 months, p=0.90). The median OS was 24.2 (18-28) months; there was a tendency towards higher survival rates in patients that were treated in ≥ second line (16.8 vs 25.2 months, 0=0.07). Conclusions: In this multiethnic cohort, the “real world” experience of the benefit of IT in HCC is encouraging, with a median OS exceeding two years. Expanded data may elucidate the differences if any, between use of IT as front vs. second line therapy, in PFS and OS.