Metastatic Colon Cancer Survival Jumps Dramatically Almost a Third of Patients May Live Five Years

Cancer Newsline - July 2009

Almost a Third of Patients May Live Five Years

Novel chemotherapy and biological agents, combined with advances in liver surgery, have increased five-year survival rates for metastatic colorectal cancer from 8% to 30% in the past 20 years.

Researchers at M. D. Anderson published the study in May in the Journal of Clinical Oncology. They also reported the median overall survival for this cancer is more than 30 months, compared to eight months for patients diagnosed before 1990.

Significance of results

Colorectal cancer is the fourth most common cancer in the United States. According to the American Cancer Society, more than 148,800 people were diagnosed with the disease in 2008, and 49,960 died because of it.

Background

Recently, several new chemotherapy treatments have become available to treat the colorectal cancer, says Scott Kopetz, M.D., assistant professor in M. D. Anderson's Department of Gastrointestinal Medical Oncology.

Also, over the past decade, surgical removal of cancerous lesions that spread to the liver has become more widely practiced.

Research methods

The researchers identified 2,470 metastatic colorectal cancer patients who were diagnosed and treated between 1990 and 2006.

They included:

1,614 treated at M. D. Anderson
856 treated at Mayo Clinic

Of these patients, 231 had liver surgery to remove tumors. Surgery was performed with increased frequency after 2000.

Researchers looked at:

Whether patients were able to have liver surgery
When liver surgery was performed
Changes in chemotherapy approaches at institutions

Primary results

From 1990 to 1997, overall survival showed no significant change from the median 14.2 months

However, these rates increased to:

18 months from 1998 to 2000
18.6 months from 2001 to 2003
29.2 months from 2004 to 2006

Five-year overall survival also increased over time.

It was:

9% for patients diagnosed between 1990 and 1997
13% for patients diagnosed between 1998 and 2000
19% for patients diagnosed between 2001 and 2003

Five-year survival for patients diagnosed between 2004 and 2006 has not been determined yet but is projected to increase to more than 30%.

Additional results

To confirm their findings, the researchers used the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER), the population-based cancer registry, to identify 49,459 patients diagnosed with metastatic colon cancer between 1990 and 2005. The data showed early evidence of similar improvements in five-year and median overall survival.

The most dramatic changes in colon cancer survivorship were during two distinct time periods that reflect the impact of liver surgery advances and new therapies.

"Beginning in 1998 and even more by 2000, we started performing higher volumes of hepatic resections, and that coincides with the initial increase in survival,” Kopetz says.

“The second stage of improvement began around 2004, simultaneous to the approval of many more chemotherapy and biological agents."

"However, these two modalities are not independent phenomena and certainly complement each other,” he says. “As chemotherapy improves, we can remove more tumors, and as surgery for metastatic disease is more commonly performed, then patients can receive more chemotherapy."

What’s next?

Kopetz says the study emphasizes the need for more chemotherapy agents, as many metastatic colorectal cancer patients are outliving treatment options.

Metastatic colorectal cancer remains an incurable disease for the majority of patients. Continued research is needed to further extend survival.

Adapted by Dawn Dorsey from an M. D. Anderson news release. http://www.mdanderson.org/news-and-publications/news/2009/m-d-anderson-study-finds-dramatic-increase-in-metastatic-colon-cancer-survival.html