Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer

Nicolette Taku; Y. Nancy Yi-Qian; George J. Chang; Ethan B. Ludmir; Kanwal Pratap Singh Raghav; Miguel A. Rodriguez-Bigas; Emma Brey Holliday; Grace L. Smith; Bruce D. Minsky; Michael J. Overman; Craig Messick; David Boyce-Fappiano; Albert C. Koong; John Michael Skibber; Eugene Jon Koay; Arvind Dasari; Cullen M. Taniguchi; Brian K. Bednarski; Van K. Morris; Scott Kopetz; Prajnan Das

doi:10.1016/j.clcc.2021.09.012

Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer

Nicolette Taku, Y. Nancy Yi-Qian, George J. Chang, Ethan B. Ludmir, Kanwal Pratap Singh Raghav, Miguel A. Rodriguez-Bigas, Emma Brey Holliday, Grace L. Smith, Bruce D. Minsky, Michael J. Overman, Craig Messick, David Boyce-Fappiano, Albert C. Koong, John Michael Skibber, Eugene Jon Koay, Arvind Dasari, Cullen M. Taniguchi, Brian K. Bednarski, Van K. Morris, Scott KopetzPrajnan Das

Research output: Contribution to journal › Article › peer-review

Abstract

PURPOSE: There has been an increase in the incidence of rectal cancer diagnosed in young adults (age < 50 years). We evaluated outcomes among young adults treated with pre-operative long course chemoradiation (CRT) and total mesorectal excision (TME).

METHODS: The medical records of 219 patients, age 18-49, with non-metastatic, cT3-4, or cN1-2 rectal adenocarcinoma treated from 2000 to 2017 were reviewed for demographic and treatment characteristics, as well as pathologic and oncologic outcomes. The Kaplan-Meier test, log-rank test, and Cox regression analysis were used to evaluate survival outcomes.

RESULTS: The median age at diagnosis was 44 years. CRT followed by TME and post-operative chemotherapy was the most frequent treatment sequence (n = 196), with FOLFOX (n = 115) as the predominant adjuvant chemotherapy. There was no difference in sex, stage, MSS/pMMR, or pCR by age (< 45 years [n = 111] vs. ≥ 45 years [n = 108]). The 5-year rates of DFS were 77.2% for all patients, 69.8% for age < 45 years and 84.7% for age ≥ 45 years (P = .01). The 5-year rates of OS were 89.6% for all patients, 85.1% for patients with age < 45 years and 94.3% for patients with age ≥ 45 years (P = .03). Age ≥ 45 years was associated with a lower risk of disease recurrence or death on multivariable Cox regression analysis (HR = 0.55, 95% CI 0.31-0.97, P = .04).

CONCLUSION: Among young adults, patients with age < 45 years had lower rates of DFS and OS, compared to those with age ≥ 45 years. These outcomes could serve as a benchmark by which to evaluate newer treatment approaches.

Original language	English (US)
Pages (from-to)	e28-e37
Journal	Clinical colorectal cancer
Volume	21
Issue number	1
DOIs	https://doi.org/10.1016/j.clcc.2021.09.012
State	Published - Mar 2022

Keywords

Colorectal cancer
Gastrointestinal cancer
Radiation oncology
Surgical oncology
Young adults
Rectal Neoplasms/epidemiology
Humans
Middle Aged
Benchmarking
Treatment Outcome
Chemoradiotherapy
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Young Adult
Disease-Free Survival
Adolescent
Adult
Neoadjuvant Therapy
Retrospective Studies
Neoplasm Staging

ASJC Scopus subject areas

Gastroenterology
Oncology

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10.1016/j.clcc.2021.09.012

Cite this

Taku, N., Yi-Qian, Y. N., Chang, G. J., Ludmir, E. B., Raghav, K. P. S., Rodriguez-Bigas, M. A., Holliday, E. B., Smith, G. L., Minsky, B. D., Overman, M. J., Messick, C., Boyce-Fappiano, D., Koong, A. C., Skibber, J. M., Koay, E. J., Dasari, A., Taniguchi, C. M., Bednarski, B. K., Morris, V. K., ... Das, P. (2022). Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer. Clinical colorectal cancer, 21(1), e28-e37. https://doi.org/10.1016/j.clcc.2021.09.012

Taku, N, Yi-Qian, YN, Chang, GJ, Ludmir, EB, Raghav, KPS, Rodriguez-Bigas, MA, Holliday, EB, Smith, GL, Minsky, BD, Overman, MJ, Messick, C, Boyce-Fappiano, D, Koong, AC, Skibber, JM, Koay, EJ, Dasari, A, Taniguchi, CM, Bednarski, BK, Morris, VK, Kopetz, S & Das, P 2022, 'Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer', Clinical colorectal cancer, vol. 21, no. 1, pp. e28-e37. https://doi.org/10.1016/j.clcc.2021.09.012

@article{fd2adb76ad8343778cb535afb1b0a39f,

title = "Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer",

abstract = "PURPOSE: There has been an increase in the incidence of rectal cancer diagnosed in young adults (age < 50 years). We evaluated outcomes among young adults treated with pre-operative long course chemoradiation (CRT) and total mesorectal excision (TME).METHODS: The medical records of 219 patients, age 18-49, with non-metastatic, cT3-4, or cN1-2 rectal adenocarcinoma treated from 2000 to 2017 were reviewed for demographic and treatment characteristics, as well as pathologic and oncologic outcomes. The Kaplan-Meier test, log-rank test, and Cox regression analysis were used to evaluate survival outcomes.RESULTS: The median age at diagnosis was 44 years. CRT followed by TME and post-operative chemotherapy was the most frequent treatment sequence (n = 196), with FOLFOX (n = 115) as the predominant adjuvant chemotherapy. There was no difference in sex, stage, MSS/pMMR, or pCR by age (< 45 years [n = 111] vs. ≥ 45 years [n = 108]). The 5-year rates of DFS were 77.2% for all patients, 69.8% for age < 45 years and 84.7% for age ≥ 45 years (P = .01). The 5-year rates of OS were 89.6% for all patients, 85.1% for patients with age < 45 years and 94.3% for patients with age ≥ 45 years (P = .03). Age ≥ 45 years was associated with a lower risk of disease recurrence or death on multivariable Cox regression analysis (HR = 0.55, 95% CI 0.31-0.97, P = .04).CONCLUSION: Among young adults, patients with age < 45 years had lower rates of DFS and OS, compared to those with age ≥ 45 years. These outcomes could serve as a benchmark by which to evaluate newer treatment approaches.",

keywords = "Colorectal cancer, Gastrointestinal cancer, Radiation oncology, Surgical oncology, Young adults, Rectal Neoplasms/epidemiology, Humans, Middle Aged, Benchmarking, Treatment Outcome, Chemoradiotherapy, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Young Adult, Disease-Free Survival, Adolescent, Adult, Neoadjuvant Therapy, Retrospective Studies, Neoplasm Staging",

author = "Nicolette Taku and Yi-Qian, {Y. Nancy} and Chang, {George J.} and Ludmir, {Ethan B.} and Raghav, {Kanwal Pratap Singh} and Rodriguez-Bigas, {Miguel A.} and Holliday, {Emma Brey} and Smith, {Grace L.} and Minsky, {Bruce D.} and Overman, {Michael J.} and Craig Messick and David Boyce-Fappiano and Koong, {Albert C.} and Skibber, {John Michael} and Koay, {Eugene Jon} and Arvind Dasari and Taniguchi, {Cullen M.} and Bednarski, {Brian K.} and Morris, {Van K.} and Scott Kopetz and Prajnan Das",

note = "Funding Information: Dr. Taku is the recipient of research funding from Varian Medical Systems. Dr. Smith has an immediate family member who has a relationship with Oncora Medical and has an immediate family member who is the recipient of research funding from Varian Medical Systems. Dr. Chang has a consulting/advisory relationship with MORE Health, Medicaroid, 11 Health, and Johnson & Johnson. He the recipient of research funding from Agendia. Dr. Koong has stock/other ownership interests in Aravive. Dr. Holliday is the recipient of research funding from Merck. Dr. Koay has a consulting/advisory relationship with Augmenix and RenovoRx. He has a speakers{\textquoteright} bureau relationship with Oncology Information Group. He has a provisional patent for 3D printed oral stents and receives royalties from Taylor and Francis LLC for a co-authored book. He is the recipient of research funding from Philips Healthcare, Elekta, and GE Healthcare. Dr. Dasari has a consulting/advisory relationship with Ipsen, Novartis, Voluntis, Lexicon, Advanced Accelerator Applications, and Hutchison MediPharma. He is the recipient of research funding from Novartis, Eisai, Hutchison MediPharma, Merck, Guardant Health, and Ipsen. Dr. Taniguchi has a consulting/advisory relationship with Accuray. He has patents for PHD inhibitors for radio protection of the GI Tract and oral amifostine for radio protection of the intestinal tract. He has received honoraria from and is a consultant for Xerient Pharmaceuticals. Dr. Morris has a consulting/advisory relationship Array Biopharma, Incyte, SERVIER, Boehringer Ingelheim, Axiom Healthcare Strategies, BioMedical Insights, Bicara Therapeutics. He has received honoraria from Projects in Knowledge. He or his institution is the recipient of research funding from Bristol-Myers Squibb, EMD Serono, Boehringer Ingelheim, Immatics, Pfizer, and BioNTech AG. Dr. Overman has a consulting/advisory relationship with Bristol-Myers Squibb, Roche/Genentech, Gritstone Oncology, MedImmune, Novartis, Promega, Spectrum Pharmaceuticals, Array BioPharma, Janssen, and Pfizer. He is the recipient of research funding from Bristol-Myers Squibb, Merck, Roche, and MedImmune. Dr. Kopetz has a consulting/advisory relationship with Roche, Genentech, EMD Serono, Merck, Navire, Symphogen, Holy Stone Healthcare, Amgen, Novartis, Lilly, Boehringer Ingelheim, Boston Biomedical, AstraZeneca/MedImmune, Bayer Health, Pierre Fabre, EMD Serono, Redx Pharma, Ipsen, Daiichi Sankyo, Natera, HalioDx, Lutris, Jacobio, Pfizer, Repare Therapeutics, Inivata, GlaxoSmithKline, and Jazz Pharmaceuticals. He has stock/other ownership interests in MolecularMatch, Navire, and Lutris. He or his institution is the recipient of research funding from Sanofi, Biocartis, Guardant Health, Array BioPharma, Genentech/Roche, EMD Serono, MedImmune, Novartis, Amgen, Lilly, and Daiichi Sankyo. Dr. Raghav has a consulting/advisory relationship with AstraZeneca, Bayer, Eisai, and Daiichi Sankyo. Dr. Das has a consulting/advisory relationship with Adlai Nortye and MD Anderson Cancer Center. Publisher Copyright: {\textcopyright} 2021",

year = "2022",

month = mar,

doi = "10.1016/j.clcc.2021.09.012",

language = "English (US)",

volume = "21",

pages = "e28--e37",

journal = "Clinical colorectal cancer",

issn = "1533-0028",

publisher = "Elsevier",

number = "1",

}

TY - JOUR

T1 - Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer

AU - Taku, Nicolette

AU - Yi-Qian, Y. Nancy

AU - Chang, George J.

AU - Ludmir, Ethan B.

AU - Raghav, Kanwal Pratap Singh

AU - Rodriguez-Bigas, Miguel A.

AU - Holliday, Emma Brey

AU - Smith, Grace L.

AU - Minsky, Bruce D.

AU - Overman, Michael J.

AU - Messick, Craig

AU - Boyce-Fappiano, David

AU - Koong, Albert C.

AU - Skibber, John Michael

AU - Koay, Eugene Jon

AU - Dasari, Arvind

AU - Taniguchi, Cullen M.

AU - Bednarski, Brian K.

AU - Morris, Van K.

AU - Kopetz, Scott

AU - Das, Prajnan

N1 - Funding Information: Dr. Taku is the recipient of research funding from Varian Medical Systems. Dr. Smith has an immediate family member who has a relationship with Oncora Medical and has an immediate family member who is the recipient of research funding from Varian Medical Systems. Dr. Chang has a consulting/advisory relationship with MORE Health, Medicaroid, 11 Health, and Johnson & Johnson. He the recipient of research funding from Agendia. Dr. Koong has stock/other ownership interests in Aravive. Dr. Holliday is the recipient of research funding from Merck. Dr. Koay has a consulting/advisory relationship with Augmenix and RenovoRx. He has a speakers’ bureau relationship with Oncology Information Group. He has a provisional patent for 3D printed oral stents and receives royalties from Taylor and Francis LLC for a co-authored book. He is the recipient of research funding from Philips Healthcare, Elekta, and GE Healthcare. Dr. Dasari has a consulting/advisory relationship with Ipsen, Novartis, Voluntis, Lexicon, Advanced Accelerator Applications, and Hutchison MediPharma. He is the recipient of research funding from Novartis, Eisai, Hutchison MediPharma, Merck, Guardant Health, and Ipsen. Dr. Taniguchi has a consulting/advisory relationship with Accuray. He has patents for PHD inhibitors for radio protection of the GI Tract and oral amifostine for radio protection of the intestinal tract. He has received honoraria from and is a consultant for Xerient Pharmaceuticals. Dr. Morris has a consulting/advisory relationship Array Biopharma, Incyte, SERVIER, Boehringer Ingelheim, Axiom Healthcare Strategies, BioMedical Insights, Bicara Therapeutics. He has received honoraria from Projects in Knowledge. He or his institution is the recipient of research funding from Bristol-Myers Squibb, EMD Serono, Boehringer Ingelheim, Immatics, Pfizer, and BioNTech AG. Dr. Overman has a consulting/advisory relationship with Bristol-Myers Squibb, Roche/Genentech, Gritstone Oncology, MedImmune, Novartis, Promega, Spectrum Pharmaceuticals, Array BioPharma, Janssen, and Pfizer. He is the recipient of research funding from Bristol-Myers Squibb, Merck, Roche, and MedImmune. Dr. Kopetz has a consulting/advisory relationship with Roche, Genentech, EMD Serono, Merck, Navire, Symphogen, Holy Stone Healthcare, Amgen, Novartis, Lilly, Boehringer Ingelheim, Boston Biomedical, AstraZeneca/MedImmune, Bayer Health, Pierre Fabre, EMD Serono, Redx Pharma, Ipsen, Daiichi Sankyo, Natera, HalioDx, Lutris, Jacobio, Pfizer, Repare Therapeutics, Inivata, GlaxoSmithKline, and Jazz Pharmaceuticals. He has stock/other ownership interests in MolecularMatch, Navire, and Lutris. He or his institution is the recipient of research funding from Sanofi, Biocartis, Guardant Health, Array BioPharma, Genentech/Roche, EMD Serono, MedImmune, Novartis, Amgen, Lilly, and Daiichi Sankyo. Dr. Raghav has a consulting/advisory relationship with AstraZeneca, Bayer, Eisai, and Daiichi Sankyo. Dr. Das has a consulting/advisory relationship with Adlai Nortye and MD Anderson Cancer Center. Publisher Copyright: © 2021

PY - 2022/3

Y1 - 2022/3

N2 - PURPOSE: There has been an increase in the incidence of rectal cancer diagnosed in young adults (age < 50 years). We evaluated outcomes among young adults treated with pre-operative long course chemoradiation (CRT) and total mesorectal excision (TME).METHODS: The medical records of 219 patients, age 18-49, with non-metastatic, cT3-4, or cN1-2 rectal adenocarcinoma treated from 2000 to 2017 were reviewed for demographic and treatment characteristics, as well as pathologic and oncologic outcomes. The Kaplan-Meier test, log-rank test, and Cox regression analysis were used to evaluate survival outcomes.RESULTS: The median age at diagnosis was 44 years. CRT followed by TME and post-operative chemotherapy was the most frequent treatment sequence (n = 196), with FOLFOX (n = 115) as the predominant adjuvant chemotherapy. There was no difference in sex, stage, MSS/pMMR, or pCR by age (< 45 years [n = 111] vs. ≥ 45 years [n = 108]). The 5-year rates of DFS were 77.2% for all patients, 69.8% for age < 45 years and 84.7% for age ≥ 45 years (P = .01). The 5-year rates of OS were 89.6% for all patients, 85.1% for patients with age < 45 years and 94.3% for patients with age ≥ 45 years (P = .03). Age ≥ 45 years was associated with a lower risk of disease recurrence or death on multivariable Cox regression analysis (HR = 0.55, 95% CI 0.31-0.97, P = .04).CONCLUSION: Among young adults, patients with age < 45 years had lower rates of DFS and OS, compared to those with age ≥ 45 years. These outcomes could serve as a benchmark by which to evaluate newer treatment approaches.

AB - PURPOSE: There has been an increase in the incidence of rectal cancer diagnosed in young adults (age < 50 years). We evaluated outcomes among young adults treated with pre-operative long course chemoradiation (CRT) and total mesorectal excision (TME).METHODS: The medical records of 219 patients, age 18-49, with non-metastatic, cT3-4, or cN1-2 rectal adenocarcinoma treated from 2000 to 2017 were reviewed for demographic and treatment characteristics, as well as pathologic and oncologic outcomes. The Kaplan-Meier test, log-rank test, and Cox regression analysis were used to evaluate survival outcomes.RESULTS: The median age at diagnosis was 44 years. CRT followed by TME and post-operative chemotherapy was the most frequent treatment sequence (n = 196), with FOLFOX (n = 115) as the predominant adjuvant chemotherapy. There was no difference in sex, stage, MSS/pMMR, or pCR by age (< 45 years [n = 111] vs. ≥ 45 years [n = 108]). The 5-year rates of DFS were 77.2% for all patients, 69.8% for age < 45 years and 84.7% for age ≥ 45 years (P = .01). The 5-year rates of OS were 89.6% for all patients, 85.1% for patients with age < 45 years and 94.3% for patients with age ≥ 45 years (P = .03). Age ≥ 45 years was associated with a lower risk of disease recurrence or death on multivariable Cox regression analysis (HR = 0.55, 95% CI 0.31-0.97, P = .04).CONCLUSION: Among young adults, patients with age < 45 years had lower rates of DFS and OS, compared to those with age ≥ 45 years. These outcomes could serve as a benchmark by which to evaluate newer treatment approaches.

KW - Colorectal cancer

KW - Gastrointestinal cancer

KW - Radiation oncology

KW - Surgical oncology

KW - Young adults

KW - Rectal Neoplasms/epidemiology

KW - Humans

KW - Middle Aged

KW - Benchmarking

KW - Treatment Outcome

KW - Chemoradiotherapy

KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use

KW - Young Adult

KW - Disease-Free Survival

KW - Adolescent

KW - Adult

KW - Neoadjuvant Therapy

KW - Retrospective Studies

KW - Neoplasm Staging

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DO - 10.1016/j.clcc.2021.09.012

M3 - Article

C2 - 34794903

AN - SCOPUS:85119297805

VL - 21

SP - e28-e37

JO - Clinical colorectal cancer

JF - Clinical colorectal cancer

SN - 1533-0028

IS - 1

ER -

Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer

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