Thiru Prasanna1, Rachel Wong2, Timothy Price3, Jeremy Shapiro4, Jeanne Tie5, Hui-Li Wong6, Louise Nott7, David Roder8, Margaret Lee9, Suzanne Kosmider10, Azim Jalali11, Matthew Burge12, Robert Padbury13, Guy Maddern14, Scott Carruthers15, James Moore16, Michael Sorich17, Christos S Karapetis18, Peter Gibbs11, Desmond Yip19. 1. Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia; ANU Medical School, Australian National University, Australia; University of Canberra, ACT, Australia. Electronic address: Thiru.prasanna@act.gov.au. 2. Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Eastern Health, Melbourne, Australia; Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia. 3. The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia. 4. Cabrini Haematology and Oncology Centre, Melbourne, Australia. 5. Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Western Hospital, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia. 6. Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia. 7. Department of Medical Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia; Menzies Research institute, Hobart, Australia. 8. South Australian Health & Medical Research Institute (SAHMRI), Australia; University of South Australia, Adelaide, Australia. 9. Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Eastern Health, Melbourne, Australia. 10. Department of Medical Oncology, Western Hospital, Melbourne, Australia. 11. Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Western Hospital, Melbourne, Australia. 12. Department of Medical Oncology, Royal Brisbane Hospital, Brisbane, Australia. 13. Flinders University, Bedford Park, Australia; Department of Surgery, Flinders Medical Centre, Australia. 14. University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia. 15. Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia. 16. Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia. 17. College of Medicine and Public Health, Flinders University, Adelaide, Australia. 18. Flinders University, Bedford Park, Australia; Department of Medical Oncology, Flinders Medical Centre, Australia. 19. Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia; ANU Medical School, Australian National University, Australia.
Abstract
BACKGROUND: Resection of oligometastases improves survival in metastatic colorectal cancer (mCRC). It is unclear whether the benefit is consistent for BRAF V600E mutant (MT) and wild type (WT) mCRC. This retrospective analysis explores the influence of BRAF MT on survival after metastasectomy. METHODS: Overall survival (OS) and recurrence-free survival (RFS) for BRAF MT and WT mCRC were evaluated. Survival was also analyzed in the cohort of BRAF MT with or without metastasectomy. RESULTS: Five hundred and thirteen patients who had undergone metastasectomy were identified, 6% were BRAF-MT. Median age 63. Median OS in BRAF MT vs WT: 25.7 vs 48.5 months (hazard ratio [HR] 1.95; 1.18-3.22). However, difference was not significant in a multivariate model. Right primary tumor, intact primary, >1 metastatic site, non-R0 resection, peritoneal metastasis, and synchronous metastasis were independent predictors of worse OS. Among 364 patients with RFS data there was no difference between BRAF MT and WT (16 vs 19 months, p=0.09). In another cohort of 158 BRAF-MT patients, OS was significantly better after metastasectomy compared to "no metastasectomy" (HR 0.34; 0.18-0.65, P= 0.001). Proficient mismatch repair status showed a trend toward worse survival after metastasectomy in BRAF MT (HR 1.71, P = 0.08). CONCLUSION: OS did not differ after metastasectomy between BRAF MT and WT in a multivariate model. Median OS was >2 years in this study after metastasectomy among BRAFV600E MT patients suggesting a survival benefit of metastasectomy in this group where systemic therapeutic options are limited. Metastasectomy may be considered in carefully selected BRAF-MT patients.
BACKGROUND: Resection of oligometastases improves survival in metastatic colorectal cancer (mCRC). It is unclear whether the benefit is consistent for BRAF V600E mutant (MT) and wild type (WT) mCRC. This retrospective analysis explores the influence of BRAF MT on survival after metastasectomy. METHODS: Overall survival (OS) and recurrence-free survival (RFS) for BRAF MT and WT mCRC were evaluated. Survival was also analyzed in the cohort of BRAF MT with or without metastasectomy. RESULTS: Five hundred and thirteen patients who had undergone metastasectomy were identified, 6% were BRAF-MT. Median age 63. Median OS in BRAF MT vs WT: 25.7 vs 48.5 months (hazard ratio [HR] 1.95; 1.18-3.22). However, difference was not significant in a multivariate model. Right primary tumor, intact primary, >1 metastatic site, non-R0 resection, peritoneal metastasis, and synchronous metastasis were independent predictors of worse OS. Among 364 patients with RFS data there was no difference between BRAF MT and WT (16 vs 19 months, p=0.09). In another cohort of 158 BRAF-MT patients, OS was significantly better after metastasectomy compared to "no metastasectomy" (HR 0.34; 0.18-0.65, P= 0.001). Proficient mismatch repair status showed a trend toward worse survival after metastasectomy in BRAF MT (HR 1.71, P = 0.08). CONCLUSION: OS did not differ after metastasectomy between BRAF MT and WT in a multivariate model. Median OS was >2 years in this study after metastasectomy among BRAFV600E MT patients suggesting a survival benefit of metastasectomy in this group where systemic therapeutic options are limited. Metastasectomy may be considered in carefully selected BRAF-MT patients.
Authors: Lucy Gately; Katharine Drummond; Mark Rosenthal; Rosemary Harrup; Anthony Dowling; Andrew Gogos; Zarnie Lwin; Ian Collins; David Campbell; Elizabeth Ahern; Claire Phillips; Hui K Gan; Iwan Bennett; Oliver M Sieber; Peter Gibbs Journal: BMC Cancer Date: 2022-06-02 Impact factor: 4.638
Authors: Noha Rashad; Mohamed Abdulla; Mohamed Farouk; Yasser Elkerm; Salem Eid Salem; Maha Yahia; Amr S Saad; Ahmed Hassan Abdel Aziz; Ghada Refaat; Ibrahim Awad; Maha ElNaggar; Khaled Kamal; Basel Refky; Mohamed Abdelkhalek; Ahmed Touny; Loay Kassem; Emad Shash; Abdelhay A Abdelhay; Bahaa Eldin Mahmoud; Karima Oualla; Nesrine Chraiet; Hussein AwadElkarim H Maki; Yasser Abdel Kader Journal: Cancer Manag Res Date: 2022-02-28 Impact factor: 3.989