A30: Impact of Different Systemic Chemotherapy Approaches on Oncologic Outcomes for Patients with Colorectal Peritoneal Metastases

Friday, March 11, 2022

11:01 AM – 11:09 AM CST

Location: Coronado

Abstract Presenter(s)

David Hanna, MD

Resident Physician
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Participants should be aware of the following financial/non-financial relationships:

David Hanna, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Introduction: Many patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for colorectal peritoneal metastases (CPM) undergo systemic chemotherapy. However, the optimal role of the treatment approach for systemic therapy is not yet understood. The primary aim of this study is to evaluate oncologic outcomes of two distinct chemotherapy approaches in patients with CPM undergoing CRS-HIPEC.

Methods: We performed a multicenter retrospective review of a prospectively maintained database of patients who underwent CRS-HIPEC for CPM due to moderately or poorly differentiated CRC between 2013 – 2019. Patients in the total neoadjuvant therapy group (TNT) received 12 cycles of preoperative chemotherapy. Patients in the “sandwich” chemotherapy group (SAND) received 6 cycles of preoperative chemotherapy with intention to treat with maximum 6 cycles of postoperative chemotherapy based on the electronic health record. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS) defined as months from date of first treatment or surgery, respectively.

Results:

A total of 79 patients were included in this analysis, with 34 (43%) patients in the TNT group and 45 (57%) patients in the SAND group, 5 (11%) of whom did not receive planned adjuvant chemotherapy. There were no significant oncologic differences between the two groups. The median number completed adjuvant chemotherapy cycles in the SAND group was 4. The median overall survival in the TNT and SAND groups were 77 and 61 months, respectively (p=0.8). However, patients in the TNT group had significantly longer RFS compared to patients in the SAND group (29 vs 12 months, p=0.02). In a multivariate analysis, TNT approach was independently associated with improved RFS [HR 2.49, 95% CI (1.27 – 3.72); p=0.03).

Conclusions: In this multicenter retrospective study, a TNT approach was associated with improved recurrence-free survival, but not improved overall survival when compared to a sandwiched chemotherapy approach. Thus, further prospective studies are needed examine these systemic chemotherapeutic approaches in patients with CPM undergoing CRS-HIPEC.

Learning Objectives:

describe two distinct systemic chemotherapuetic approaches for patients with colorectal peritoneal metastases undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy
understand the different oncologic outcomes seen in different systemic chemotherapuetic approaches for patients with colorectal peritoneal metastases undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy
demonstrate that a total neoadjuvant chemotherapy approach is associated with improved recurrence-free survial when compared to a sandwich chemotherapy approach in patients with colorectal peritoneal metastases.