Download Patterns of Care in Medical Oncology

Patterns of Care in
Medical Oncology
Adjuvant Systemic Therapy
for Colon Cancer
Approximately what percent of your patients with Stage II
colon cancer receive adjuvant chemotherapy?
Clinical investigators (CI)
2006
2007
2008
Mean
52%
50%
45%
Practicing oncologists (PO)
2006
2007
2008
Mean
46%
42%
34%
Phase III randomized study of oxaliplatin, leucovorin
calcium and fluorouracil with or without bevacizumab
in patients with resected Stage II colon cancer
Protocol ID: ECOG-E5202
Target Accrual: 3,610 (Open)
FOLFOX
Eligibility
Stage II (T3-4, N0, M0)
with paraffinembedded tumor
specimen available
High risk*
Low risk*
R
FOLFOX +
bevacizumab
Observation
* Patients are stratified according to disease stage (IIA versus IIB), microsatellite
stability status (microsatellite stable [MSS] or microsatellite instable [MSI]) and
presence or absence of heterozygosity at chromosome 18q. Patients deemed to
be at high risk based on these molecular parameters are randomly assigned to
one of two treatment arms (arms I and II), whereas patients at low risk are
assigned to arm III.
Phase III randomized study of oxaliplatin, leucovorin
calcium and fluorouracil with or without bevacizumab
in patients with resected Stage II colon cancer
Study Contacts
Eastern Cooperative Oncology Group
Al Benson, MD, FACP, Protocol Chair
Tel: 312-695-6180
Peter O’Dwyer, MD, BCh, Protocol Co-Chair
Tel: 215-662-7606
Email: [email protected]
Source: NCI Physician Data Query, November 2008.
Have you used Peter Ravdin’s Adjuvant! Online program
for colon cancer?
64%
% answering yes
49%
With approximately how many patients during the past year
have you used Peter Ravdin’s Adjuvant! Online program for
treatment of colon cancer?
8
Median
Clinical investigators
Practicing oncologists
20
Approximately what percent of your patients with Stage II and
III colon cancer do you think have a solid understanding of the
following after consulting with you?
Risks of adjuvant chemotherapy
Mean
75%
66%
75%
74%
Benefits of adjuvant chemotherapy
Mean
Clinical investigators
Practicing oncologists
Which of the following, if any, is your preferred 5-FU +
leucovorin + oxaliplatin regimen in the adjuvant setting?
Modified FOLFOX6
72%
51%
FOLFOX4
4%
28%
FOLFOX6
4%
17%
Modified FOLFOX7
16%
3%
I do not use FOLFOX or FLOX in
the adjuvant setting
0%
1%
Other
4%
0%
Clinical investigators
Practicing oncologists
When administering oxaliplatin-containing chemotherapy
in the adjuvant setting, how often do you generally
administer intravenous calcium and magnesium for
neuroprotection?
Always
0%
7%
Usually
20%
13%
Sometimes
40%
28%
Rarely
20%
22%
Never
20%
30%
Clinical investigators
Practicing oncologists
Case 1: Adjuvant Therapy for Patients with Stage III
Colon Cancer
Woman in average health
 T3 tumor in the left descending colon
 15/25 lymph nodes positive
65-year-old patient
Which adjuvant chemotherapy regimen, if any, are you most
likely to recommend for this patient at the following ages?

FOLFOX
100%
83%
FOLFOX + bevacizumab
0%
11%
Other chemotherapy
0%
6%
Clinical investigators
Practicing oncologists
Case 1: Adjuvant Therapy for Patients with Stage III
Colon Cancer



Woman in average health
T3 tumor in the left descending colon
15/25 lymph nodes positive
85-year-old patient
Which adjuvant chemotherapy regimen, if any, are you most
likely to recommend for this patient at the following ages?
FOLFOX
60%
32%
FOLFOX + bevacizumab
0%
3%
Capecitabine
28%
34%
5-FU/LV (infusion or bolus)
8%
21%
Other chemotherapy
4%
7%
No systemic therapy
0%
3%
Clinical investigators
Practicing oncologists
Have you used bevacizumab off protocol in the adjuvant
setting?
12%
% answering yes
14%
(For those answering yes): In approximately how many
patients have you used bevacizumab in the adjuvant setting
in the past year?
4
Median
Clinical investigators
Practicing oncologists
6
AVANT adjuvant study: A Phase III randomized trial
comparing FOLFOX to FOLFOX with bevacizumab to
CAPOX with bevacizumab in patients with resected
colon cancer
Target Accrual: 3,450 (Closed)
Protocol IDs: UCLA-0412086-01, ROCHE-BO17920A, NCT00112918
Eligibility
FOLFOX x 6 months
High-risk Stage II or
III colon cancer
• Curative surgery
within the past
four to eight weeks
• No clinically significant
cardiovascular disease*
[FOLFOX + bevacizumab] x
6 months followed by
bevacizumab x 6 months
R
[CAPOX + bevacizumab] x
6 months followed by
bevacizumab x 6 months
* Cerebrovascular accident within the past six months; myocardial
infarction within the past year; uncontrolled hypertension while on
chronic medication; unstable angina; NYHA Class II-IV heart failure;
serious cardiac arrhythmias that require medication. A cardiac
monitoring plan is included in this study.
AVANT adjuvant study: A Phase III randomized trial
comparing FOLFOX to FOLFOX with bevacizumab to
CAPOX with bevacizumab in patients with resected
colon cancer
Study Contact
Joel Hecht, MD
Tel: 888-798-0719
Source: NCI Physician Data Query, November 2008.
Practicing oncologists should be discussing the potential
impact on risk of recurrence of the following with patients
diagnosed with colon cancer:
Exercise
Agree
76%
68%
In between
16%
26%
Disagree
8%
6%
Clinical investigators
Practicing oncologists
Practicing oncologists should be discussing the potential
impact on risk of recurrence of the following with patients
diagnosed with colon cancer:
Diet
Agree
60%
66%
In between
28%
30%
Disagree
12%
4%
Clinical investigators
Practicing oncologists