Which adjuvant systemic treatments (AdjRx) would medical oncologists (MOs) wish to receive if they had colon cancer (CCa)? A survey of 150 physicians
Authors: N. Love, N. J. Meropol, P. M. Ravdin, C. Bylund, L. M. Ellis, A. Grothey, H. J. Lenz, J. L. Marshall, S. A. Curly, D. Paley, M. Elder
Journal: Journal of Clinical Oncology (2008)

4049 Background: Decisions about AdjRx for CCa lead some patients (Pts) to ask MOs what they would do in the same situation. We wished to understand how often Pts ask MOs what therapy they would choose as a Pt and how MOs respond. Methods: 150 US-based MOs were recruited for a survey focused on several AdjRx scenarios. MOs were asked how they manage CCa and what treatment they would choose for themselves in the described situations. Results: MOs (median age 48, 75% male) estimated that 41% of Pts with CCa ask how they would be treated, and 70% of MOs regularly provide an answer. For Stage III CCa, oxaliplatin-based chemotherapy or clinical trial participation were more common choices than off-study chemo/biologic therapy (Table 1). Trials evaluating bevacizumab were favored over studies with cetuximab (p<0.01). For Stage II CCa with only eight nodes examined, 86% of MOs would receive AdjRx. 47% of MOs would receive AdjRx for lower-risk Stage II CCa, but when presented only with a set of recurrence risks derived from Adjuvant! Online for a similar case, 97% would want AdjRx. Overall, MO recommendations to Pts were identical for 73% of responses. Conclusions: Although it is unclear if MOs should communicate their potential treatment choices to Pts, many do so when asked, and generally recommend treatments they would elect as Pts. Most MOs would not receive off-study biologics even for high-risk Stage III disease, and clinical trials evaluating these agents were more common choices. About half of MOs would be treated in a situation perceived qualitatively as “low-risk Stage II,” yet almost all would be treated based on the quantitative risk reductions for a similar case as described in Adjuvant! Online. This suggests that MOs would receive treatment for a modest reduction in recurrence risk if they were convinced there was that benefit. More research is required to better understand these complex issues. Table 1: MO treatment preferences if they were diagnosed with colon cancer Treatment Stage III Higher- risk Stage II Lower-risk Stage II 2/18 node-positive 15/18 node-positive 0/8 nodes No high risk features, 0/18 nodes Risk-calculation data presented only1 FOLFOX/CAPOX 51% 27% 56% 17% 86% Clinical trial: FOLFOX vs FOLFOX/bevacizumab 31% 42% N/A2 N/A N/A Clinical trial: FOLFOX vs FOLFOX/cetuximab 3% 3% N/A N/A N/A Chemotherapy + bevacizumab 3 13%4 27%5 0% 0% 0% 5-FU/LV alone 1% 0% 14% 13% 4% Capecitabine alone 1% 1% 14% 17%6 7% No chemotherapy 0% 0% 16% 53%7 3% 1 According to Adjuvant! Online (age 55, Grade I, T3N0M0 with > 10 nodes identified). Baseline five-year recurrence risk = 13%; risk with fluoropyrimidine = 10.5%; risk with oxaliplatin/fluoropyrimidine = 8.1% 2 N/A = Not applicable, case asked for non-protocol treatment only 3 FOLFOX + bevacizumab = 11% and 26% for 2/18N+ and 15/18N+ cases, respectively 4 Significantly different from MO patient recommendation of 7% (p<0.05) 5 Significantly different from MO patient recommendation of 11% (p<0.05) 6 Significantly different from MO patient recommendation of 8% (p<0.05) 7 Significantly different from MO patient recommendation of 70% (p<0.05). Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amgen Inc, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Genentech BioOncology, Genomic Health, ImClone Systems, Merck and Company Inc, Novartis Pharmaceuticals Corporation, Pfizer Inc, Response Genetics Inc, Roche Laboratories Inc, sanofi-aventis Adjuvant! Inc Amgen Inc, Bristol-Myers Squibb Company, Genentech BioOncology, Pfizer Inc, Roche Laboratories Inc, sanofi-aventis Amgen Inc, AstraZeneca Pharmaceuticals LP, CTEP, ImClone Systems, NCI/NIH, sanofi-aventis, SWOG Amgen Inc, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Eli Lilly, Genentech BioOncology, ImClone Systems, Novartis Pharmaceuticals Corporation, Pfizer Inc, Roche Laboratories Inc, sanofi-aventis