In a pooled analysis reported in the Journal of Clinical Oncology, Rahbari et al found that primary tumor resection before chemotherapy did not extend survival compared with upfront chemotherapy in patients with colon cancer and unresectable metastases.
Study Details
The study involved data from the SYNCHRONOUS and CCRe-IV trials, in which a total of 393 patients from sites in Austria, Germany, and Spain were randomly assigned between November 2011 and March 2017 to undergo primary tumor resection followed by chemotherapy (PTR group; n = 187) or chemotherapy alone (no-PTR group; n = 206). Patients with tumor-related symptoms, an inability to tolerate surgery or systemic chemotherapy, or a history of another cancer were excluded from the trials. Systemic chemotherapy was selected by treating physicians. The primary endpoint was overall survival in the intention-to-treat population.
Key Findings
Overall, 24.1% of patients in the PTR group and 6.4% of those in the no-PTR group did not receive chemotherapy.
Median follow-up was 36.7 months (95% confidence interval [CI] = 36.6–37.3 months). Median overall survival was 16.7 months (95% CI = 13.2–19.2 months) in the PTR group vs 18.6 months (95% CI = 16.2–22.3 months) in the no-PTR group (P = .191). The difference remained nonsignificant on multivariate analysis (hazard ratio = 0.944, 95% CI = 0.738–1.209, P = .65). Outcomes were similar across all subgroups examined.
In the per-protocol population, with a median follow-up of 36.6 months (95% CI = 36.5–37.1 months), median overall survival was 18.0 months (95% CI = 15.4–21.1 months) in the PTR group vs 18.0 months (95% CI = 15.0–21.1 months) in the no-PTR group (P = .719).
Serious adverse events occurred in 10.2% of those in the PTR group vs 18.0% of those in the no-PTR group (P = .027).
The investigators concluded: “Among patients with colon cancer and synchronous unresectable metastases, primary tumor resection before systemic chemotherapy was not associated with prolonged overall survival.”
Jürgen Weitz, MD, MSc, of the University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany, is the corresponding author of the Journal of Clinical Oncology article.
Disclosure: The study was supported by a grant from Deutsche Forschungsgemeinschaft. For full disclosures of the study authors, visit ascopubs.org.
