2 research outputs found
Patients with early-onset metastatic colorectal cancer as an emerging distinctive clinical and molecular phenomenon
Background: Despite a reduction of both incidence and mortality from CRC in the elderly
population, several studies published in the last decade have shown an increase in the incidence
of early-onset CRC (EO-CRC), conventionally defined as cancer that occurs in adults between
the ages of 18 and 49. Clinical and prognostic data on this setting are limited and conflicting. The
aim of our study was to evaluate the clinical, prognostic, and molecular profiles of metastatic
EO-CRC patients (age at diagnosis # 50) in order to identify potentially relevant differences
compared to a control group late-onset CRC (LO-CRC). Methods: We retrospectively collected
data from 1272 metastatic colorectal cancers from 5 different Italian Institutions: 693 (54.5%)
EO-CRC and 579 (45.5%) LO-CRC as control group. All patients had one or more metastatic
sites, molecular profiling available (including RAS, BRAF, and MSI status), and underwent at
least one line of treatment for metastatic disease. The main objective of the study was to the
evaluate clinical outcome for the global population of EO-CRC patients in different clinical and
molecular subgroups according to RAS and BRAF status and in comparison to patients included
in the control group. Results: In the EO-CRC group median age was 42.8 (20.0-50.9) and 66.7
(51.0-86.2) in the control group. M/F ratios were 1:1 and 2:1, respectively. In the overall
population, mOS was 34,7 in EO-CRC pts vs 43,0 months (mo) (p , 0,0001) in the control
group. In the RAS/BRAF mutated subgroup mOS in EO-CRC pts was 30,3 vs 34,0 mo in the
control group (p = 0,0156). In RAS/BRAF wild-type subgroup mOS in EO-CRC pts was 43,0 vs
50,0mo(p = 0,0290). Finally, in the BRAF V600E mutated subgroup EO-CRC pts showed a 16mo
mOS vs 26mo (p = 0,04). In the overall population, mPFS was 11,0 in EO-CRC pts vs 14,0 mo (p,
0,0001) in the control group. Furthermore, the overall response rate (ORR) was 63% in EO-CRC
and 67% in LO-CRC. Conclusions: Findings from a large population of EO-CRC patients
indicate a general worse prognosis for patients with early-onset colorectal cancer compared
to late-onset patients. Interestingly this seems to occur regardless of the molecular status.
These observations might have a considerable impact on clinical practice and research. Subsequent
investigations will be needed to further understand the specific clinical and molecular
characteristics of this growing group of patients to better define the more appropriate treatment
strateg
Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group
Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice