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Impact of Complete Response to Chemotherapy on Overall Survival in Advanced Colorectal Cancer: Results From Intergroup N9741

Grace K. Dy, James E. Krook, Erin M. Green, Daniel J. Sargent, Thierry Delaunoit, Roscoe F. Morton, Charles S. Fuchs, Ramesh K. Ramanathan, Stephen K. Williamson, Brian P. Findlay, Barbara A. Pockaj, Robert P. Sticca, Steven R. Alberts, Henry C. Pitot, IV, Richard M. Goldberg

From the Mayo Clinic and Mayo Foundation, Rochester; Duluth CCOP, Duluth, MN; Jolimont Hospital, La Louvière, Belgium; Iowa Oncology Research Association CCOP, Des Moines, IA; Dana Farber Cancer Center Institute, Boston, MA; University of Pittsburgh Medical Center and Cancer Center, Pittsburgh, PA; University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St Catharines, Ontario, Canada; University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND; and the University of North Carolina at Chapel Hill, Chapel Hill, NC

Address reprint requests to: Grace K. Dy, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: dy.grace{at}mayo.edu

Purpose: To evaluate clinical characteristics and survival outcomes among patients with locally advanced or metastatic colorectal cancer who achieve a complete response (CR) to systemic treatment either alone or with multimodality approach.

Patients and Methods: Data were collected retrospectively from CRC patients enrolled onto the phase III trial N9741, a National Cancer Institute–funded and Gastrointestinal Cancer Intergroup–sponsored study coordinated by the North Central Cancer Treatment Group. Patients were randomly assigned to combinations of oxaliplatin, fluorouracil (FU)/leucovorin (LV) and irinotecan. The three treatment arms consist of IFL (irinotecan + FU/LV), FOLFOX4 (oxaliplatin + FU/LV), and IROX (irinotecan + oxaliplatin). Median follow-up was 42.6 months.

Results: Sixty-two (4%) of 1,508 patients had a CR to chemotherapy alone, and an additional 32 (2%) had a CR after multimodality treatment. Factors associated with achieving CR with systemic chemotherapy alone included FOLFOX4 treatment, patients with assessable disease, or a single site of metastasis. Continuing protocol treatment beyond two cycles after documentation of CR was not associated with improved survival. The rate of curative intent resection was significantly higher for patients treated with oxaliplatin-containing regimens (P = .02). Median survival was similar between patients with CR after chemotherapy alone (44.3 months) or after multimodality approach (47.4 months; P = .81).

Conclusion: FOLFOX4 was more likely to produce a CR than were IFL or IROX. Oxaliplatin regimens were more likely to result in successful surgical resections. Patients who have CR to systemic chemotherapy alone can achieve impressive survival outcomes similar to those seen among patients who attained a CR status after multimodality treatment.

Supported in part by Public Health Service Grant Nos. CA-25224, CA-32102, CA-38926, CA-21115, CA-37404, CA-35195, CA-35101.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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