CC BY-NC-ND 4.0 · South Asian J Cancer 2022; 11(04): 293-298
DOI: 10.1055/s-0041-1736203
Original Article
Gastrointestinal Cancer

Treatment of Metastatic Colorectal Cancers in Resource-Constrained Low- and Middle-Income Countries (LMICS) Scenario—Outcomes, Practice Patterns, and Commentary on Treatment Costs

Anant Ramaswamy
1   Department of Medical Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
,
Vasu Babu
1   Department of Medical Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
,
Rushabh Kothari
1   Department of Medical Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
,
Ram Abhinav
1   Department of Medical Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
,
Ashwin Desouza
2   Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
,
Pradeep Ventrapati
1   Department of Medical Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
,
Amit Kumar
1   Department of Medical Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
,
1   Department of Medical Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
,
Shasanka Das
1   Department of Medical Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
,
3   Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
,
Avanish Saklani
2   Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
,
Vikas Ostwal
1   Department of Medical Oncology, Tata Memorial Hospital, HBNI, Dr. E Borges Road, Parel, Mumbai, India
› Author Affiliations
Funding None.

Abstract

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Anant Ramaswamy

Introduction The overall survival (OS) of metastatic colorectal cancers (mCRCs) in clinical practice and resource-constrained low- and middle-income countries (LMICS) like India is not known.

Materials and Methods Data of patients with mCRC treated between January 2013 and August 2017 were accessed from a prospectively maintained database. Demographics, disease characteristics, chemotherapeutic regimens, use of monoclonal antibodies, and survival outcomes in treated patients were collected and analyzed. Costs of treatment options as off 2017 were also interpreted.

Results The data of 403 patients satisfied prespecified inclusion criteria and were included for analysis. The median age of the cohort was 48 years (range: 17–86) with a predominance of rectal cancers (63.3%), liver alone metastases (47.1%), and resected primary (69.7%). Signet ring histology was present in 82 patients (20.3%). The most commonly used first-line regimen (CT1) was modified capecitabine-oxaliplatin (53.3%). Two hundred and nineteen patients (54.3%) received second-line systemic therapy (CT2). Patients received a median of two lines of therapy (range: 1–6). MoAbs were used by 48 patients (13.4%) with CT1 and 34 patients (15.5%) with CT2. Median OS of the entire cohort was 17.61 months (95% confidence interval: 15.48–19.74), which was within the predicted range, as per investigator hypothesis. The presence of signet ring histology (p<0.001), raised carcinoembryonic antigen at baseline (p=0.017), and the absence of a resected primary (p<0.001) predicted inferior median OS.

Conclusions Survival of patients with mCRC in a resource-constrained LMIC scenario like India is approximately 12 to 15 months lower than published trial data. Limited access to targeted therapy and newer expensive treatment options due to financial constraints may contribute to this disparity.

Supplementary Material



Publication History

Article published online:
02 September 2022

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