Survey Reveals Inconsistent Use of Metastasis-Directed Therapy in Colorectal Cancer

Medical oncologists are less likely than other oncology specialists to consider metastasis-directed therapy (MDT) for colorectal cancer, according to a survey published in Clinical Colorectal Cancer.

Researchers surveyed 16 medical oncologists, 16 radiation oncologists, and 15 surgical oncologists to gauge their opinions and recommendations regarding MDT in patients with metastatic colorectal cancer.

The 18-question online survey was developed based on a systematic review of the literature and included clinical vignettes.

Most survey respondents (60%) said the most important reason for considering MDT in patients with metastatic colorectal cancer was prolonging overall survival (OS). About half of respondents (49%) said the second most important reason was prolonging disease-free survival (DFS), and 40% of respondents said the third most important reason was providing a break from systemic therapy.

Respondents were asked to provide a 5-year metric that is reasonable to warrant consideration of MDT. Their answers resulted in a median 5-year DFS rate of 30% and a median OS rate of 30%. Answers were similar across specialties.

When respondents were asked about the minimum time of stable disease after treatment that warranted MDT, the resulting median time was 6 months. Surgical oncologists (43%) were more likely than medical oncologists (19%) or radiation oncologists (6%) to advocate for periods of 12 months or more (P =.056).

Medical oncologists were generally less willing than the other oncologists to offer MDT to patients with more extensive or more advanced disease. For patients who had 3 liver lesions with a bilobar distribution and no other lesions, all surgical and radiation oncologists said they would consider MDT, compared with 67% of medical oncologists (P =.004).

For patients who had 3 liver lesions with a bilobar distribution and a single lung metastasis, all surgical and radiation oncologists said they would consider MDT, compared with 60% of medical oncologists (P =.001).

For patients with 3 liver metastases in a bilobar distribution and 3 lung metastases with a bilateral distribution, none of the medical oncologists said they would consider MDT, compared with 38% of radiation oncologists and 55% of surgical oncologists (P =.003).

The variability in responses between the specialists “highlights differing opinions on management of these patients and underscores the need for well-designed prospective randomized trials to characterize the risks and potential benefits of MDT,” the researchers wrote.

This article originally appeared on Cancer Therapy Advisor