Therapeutic Results of Immediately Metastatic Colorectal Cancer (MCRC) in Tunisia: Compliance to ESMO Guidelines

Abstract

Background: The median survival for patients with mCRC has progressively increased over the past decades. Resection of metastatic disease in the liver or lung is thought to be the only chance of cure for patients with mCRC. Nevertheless, long-term survival is achieved in only a minority of patients with a multimodal treatment approach. Methods: A retrospective study was conducted on patients ( pts) with histologically confirmed immediately mCRC treated at the department of medical oncology of Abderrahmane Mami hospital during 8 years (2003-2011). The optimal treatment strategy of all patients with mCRC has been discussed in a multidisciplinary team. We analyzed their epidemiological, anatomo-clinical features, treatment, compliance to ESMO guidelines and therapeutic results. Results: 46 patients ( pts) were studied. Median age was 57 years (32-77 years). Sex-ratio was 1.3. 86% had 1 organ involved, 13% had more than 2 organs involved. Out of the remaining 46 pts, 5 pts underwent surgery or a procedure directed to the metastatic site with curative intent. All patients were treated with a first line chemotherapy (CT): Folfox alone in 60% or associated with Avastin 8.5%, Folfiri 21% and LV5FU 8%. An objective response rate after first-line CT of 52% (7 complete responses plus 17 partial responses) was attained. 8 pts with hepatic metastases were treated with radiofrequency ablation. Compliance to ESMO guidelines with first line CT was obtained in all pts and in 92% with second and third line CT. The 3-year overall (OS) survival rate was 73%. Median OS was 17 months (6-70 months). Conclusion: mCRC affect relatively young patients in Tunisia, compared to western countries and therapeutic results impaired by delayed diagnosis and important/ multifocal tumor volume. Protocols applied in Tunisian are compliant with ESMO guidelines, despite more rationalized restrictions in targeted therapies (Bevacizumab, cetuximab) due to socioeconomic pressure.