Practice Patterns and Outcomes in Advanced Colorectal Cancers From a Multi-Institutional Analysis: Real-World Evidence From India

PURPOSE There are limited data on presentation and practice patterns, survival, and factors influencing overall survival (OS) in Indian patients with metastatic colorectal cancers (mCRCs). PATIENTS AND METHODS The current study evaluated patients from 13 institutions across India diagnosed with mCRC and treated from January 2016 to May 2022. The primary end point of the study was the estimation of median OS by the Kaplan-Meier method. RESULTS The data of 3,009 patients were submitted, of whom 2,520 were feasible for analysis. Molecular testing for rat sarcoma virus and/or B-Rapidly Accelerated Fibrosarcoma status via the polymerase chain reaction or next-generation sequencing was conducted in 993 patients (39%). At a median follow-up of 44.6 months (95% CI, 40.8 to 48.3), the median OS for the entire cohort was 18.7 months (95% CI, 18.0 to 19.4). The presence of signet ring (SR) histology (14.65 v 19.15 months, hazard ratio [HR] 1.30 [95% CI, 1.14 to 1.48]; P < .001) and Eastern Cooperative Oncology Group performance status (ECOG PS) 2 versus ECOG PS 0 or 1 (18.0 v 22.87 months, HR 1.37 [95% CI, 1.21 to 1.55]; P < .001) predicted inferior OS, whereas the receipt of monoclonal antibodies (MAbs; 21.81 v 16.92 months, HR 0.79 [95% CI, 0.72 to 0.87]; P < .001) and exposure to greater than two lines of therapy (26.71 v 16.26 months, HR 0.56 [95% CI, 0.50 to 0.62]; P < .001) were associated with improved OS. CONCLUSION The current multi-institutional analysis of more than 2,500 patients with mCRC in India establishes a baseline with regard to clinicopathologic characteristics, molecular testing patterns, and survival. It recognizes the importance of impaired ECOG PS, SR histology, exposure to MAbs, and multiple lines of systemic therapeutic options as factors influencing OS.