Moretto Roberto, Rossini Daniele, Zucchelli Gemma, Lonardi Sara, Bergamo Francesca, Santini Daniele, Cupini Samanta, Tomasello Gianluca, Caponnetto Salvatore, Zaniboni Alberto, Antoniotti Carlotta, Pietrantonio Filippo, Buonadonna Angela, Marmorino Federica, Bordonaro Roberto, Fea Elena, Tamburini Emiliano, Boccaccino Alessandra, Grande Roberta, Aprile Giuseppe, Falcone Alfredo, Cremolini Chiara
Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Eur J Cancer. 2020 Nov;139:81-89. doi: 10.1016/j.ejca.2020.08.009. Epub 2020 Sep 23.
Oligometastatic disease (OMD) identifies tumours with limited metastatic spread. OMD definition is not univocal and no data from clinical trials are available about the prognostic effect of OMD in metastatic colorectal cancer (mCRC), the impact of locoregional treatments (LRTs) and the effect of chemotherapy intensification in these patients. The role of tumour burden (TB) in driving therapeutic choices is also debated.
We performed a pooled analysis of phase III TRIBE and TRIBE2 studies comparing FOLFOXIRI/bevacizumab (bev) to doublets (FOLFOX or FOLFIRI)/bev. Patients were grouped in OMD versus non-OMD based on the European Society for Medical Oncology definition. Among patients with OMD, those with OMD/low TB were compared with all the others.
Of 1187 patients enrolled, 1096 were classified as OMD (N = 312 [28%]) or non-OMD (N = 784 [72%]). Among patients with OMD, 126 (40%) were OMD/low TB. OMD was associated with longer progression-free survival (14.0 versus 10.1 months; p < 0.01) and overall survival (38.2 versus 22.0 months; p < 0.01). These results were confirmed in multivariable models. The benefit provided by FOLFOXIRI/bev compared with doublets/bev did not differ in accordance with OMD and TB (p for interaction >0.05). Patients with OMD underwent LRTs more frequently (p < 0.01) and those with OMD/low TB had higher chance to undergo LRTs after the first progression (p < 0.01).
OMD is a positive prognostic factor in mCRC. The benefit from the upfront treatment intensification is independent of the metastatic spread extent and TB. LRTs should be highly considered in these patients, mainly during the first-line therapy but also at later stages of treatment history in selected cases.
寡转移疾病（OMD）指转移扩散有限的肿瘤。OMD的定义并不明确，且尚无来自临床试验的数据表明OMD对转移性结直肠癌（mCRC）的预后影响、局部区域治疗（LRT）的作用以及化疗强化对这些患者的疗效。肿瘤负荷（TB）在驱动治疗选择中的作用也存在争议。
我们对III期TRIBE和TRIBE2研究进行了汇总分析，比较FOLFOXIRI/贝伐单抗（bev）与双联方案（FOLFOX或FOLFIRI）/bev。根据欧洲医学肿瘤学会的定义，将患者分为OMD组和非OMD组。在OMD患者中，将OMD/低TB患者与其他所有患者进行比较。
在1187名入组患者中，1096名被分类为OMD（n = 312 [28%]）或非OMD（n = 784 [72%]）。在OMD患者中，126名（40%）为OMD/低TB。OMD与更长的无进展生存期（14.0对10.1个月；p < 0.01）和总生存期（38.2对22.0个月；p < 0.01）相关。这些结果在多变量模型中得到证实。与双联方案/bev相比，FOLFOXIRI/bev提供的益处并未因OMD和TB而有所不同（交互作用p>0.05）。OMD患者更频繁地接受LRT（p < 0.01），且OMD/低TB患者在首次进展后接受LRT的机会更高（p < 0.01）。
OMD是mCRC的一个积极预后因素。 upfront治疗强化带来的益处与转移扩散程度和TB无关。应高度考虑对这些患者进行LRT，主要是在一线治疗期间，但在某些特定情况下，治疗过程的后期阶段也应考虑。
