Anti-VEGF Therapy Possibly Extends Survival in Patients With Colorectal Brain Metastasis by Protecting Patients From Neurologic Disability

Chih-Wen Chen; Tao-Shen Ou; Wei-Shone Chen; Jeng-Kai Jiang; Shung-Haur Yang; Huann-Sheng Wang; Shih-Ching Chang; Yuan-Tzu Lan; Chun-Chi Lin; Hung-Hsin Lin; Sheng-Chieh Huang; Hou-Hsuan Cheng; Yi-Wen Yang; Yu-Zu Lin; Yee Chao; Ling-Wei Wang; Hao-Wei Teng

doi:10.1016/j.clcc.2023.03.003

Anti-VEGF Therapy Possibly Extends Survival in Patients With Colorectal Brain Metastasis by Protecting Patients From Neurologic Disability

Clin Colorectal Cancer. 2023 Sep;22(3):267-279. doi: 10.1016/j.clcc.2023.03.003. Epub 2023 Mar 28.

Authors

Chih-Wen Chen¹, Tao-Shen Ou², Wei-Shone Chen³, Jeng-Kai Jiang³, Shung-Haur Yang⁴, Huann-Sheng Wang³, Shih-Ching Chang³, Yuan-Tzu Lan³, Chun-Chi Lin³, Hung-Hsin Lin³, Sheng-Chieh Huang³, Hou-Hsuan Cheng³, Yi-Wen Yang³, Yu-Zu Lin³, Yee Chao⁵, Ling-Wei Wang⁶, Hao-Wei Teng⁷

Affiliations

¹ Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² Division of Allergy, Immunology, Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Surgery, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁵ Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁶ Department Heavy Particles and Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: lwwang@vghtpe.gov.tw.
⁷ Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: hwteng1971@gmail.com.

PMID: 37098452
DOI: 10.1016/j.clcc.2023.03.003

Abstract

Background: Colorectal brain metastases (CBMs) are rare with poor prognosis. There is still no standard systemic treatment for multiple or unresectable CBM. our study aimed to explore the impact of anti-VEGF therapy on overall survival, brain-specific disease control, and neurologic symptom burden in patients with CBM.

Methods: A total of 65 patients with CBM under treatment were retrospectively enrolled and divided into anti-VEGF based systemic therapy or non-anti-VEGF based therapy. A total of 25 patients who received at least 3 cycles of anti-VEGF agent and 40 patients without anti-VEGF therapy were analyzed by endpoints of overall survival (OS), progression-free survival (PFS), intracranial PFS (iPFS) and neurogenic event-free survival (nEFS). Gene expression in paired primary metastatic colorectal cancer (mCRC), liver, lung and brain metastasis from NCBI data was analyzed using top Gene Ontology (GO) and cBioPortal.

Results: Patients who treated with anti-VEGF therapy had significantly longer OS (19.5 vs. 5.5 months, P = .009), iPFS (14.6 vs. 4.1 months, P < .001) and nEFS (17.6 vs. 4.4 months, P < .001). Patients who received anti-VEGF therapy beyond any disease progression presented with superior OS (19.7 vs. 9.4 months, P = .039). Top GO and cBioPortal analysis revealed a stronger molecular function of angiogenesis in intracranial metastasis.

Conclusions: Anti-VEGF based systemic therapy showed favorable efficacy that was reflected in longer overall survival, iPFS and NEFS in patients with CBM.

Keywords: Anti-angiogenesis therapy; Colorectal cancer; Gene Ontology; Overall Survival.

MeSH terms

Antineoplastic Combined Chemotherapy Protocols
Brain Neoplasms* / drug therapy
Brain Neoplasms* / secondary
Colorectal Neoplasms* / drug therapy
Colorectal Neoplasms* / genetics
Colorectal Neoplasms* / pathology
Humans
Progression-Free Survival
Retrospective Studies