OBJECTIVES: Colorectal cancer (CRC) is the third most common cancer worldwide. To help assess the disease burden, there is a need to understand real-world treatment patterns and sequencing in the metastatic CRC (mCRC) population. The study objectives were to evaluate demographic and clinical characteristics of mCRC patients and describe treatment patterns and sequencing by line of therapy (LOT).

METHODS: This retrospective observational cohort analysis utilized the Optum’s de-identified Clinformatics® Data Mart Database (2015-2022). Eligible mCRC patients were ≥18 years of age and had ≥2 independent diagnoses for a secondary malignant neoplasm. Descriptive analyses reported treatment use by LOT. A rule-based LOT algorithm was applied to derive treatment patterns and a Sankey diagram was used to visualize treatment sequences.

RESULTS: Among 18,656 adults included in the study population, 55% were male and 64% were White with a mean (SD) age of 67 (13) years. The most common comorbidities were diabetes without chronic complications (41%), mild liver disease (32%), and chronic pulmonary disease (20%). Over half of the patients had 1-2 metastases (54%) and the most prevalent site of metastasis was liver (62%) followed by lymph nodes (51%) and thorax (37%). FOLFOX-based regimens (including FOLFOX +/- bevacizumab) were most commonly prescribed in first-line (48%) with decreasing use (<20%) in subsequent LOTs. FOLFIRI-based regimens were commonly used in second-line (33%). The use of post-chemotherapy standard-of-care (regorafenib or TAS-102) was low (<20%).

CONCLUSIONS: Real-world treatment patterns in mCRC are quite varied in later LOTs and characterized by the utilization of a wide variety of chemotherapy and targeted therapy. Also, minimal use of regorafenib or TAS-102 and substantial recycling of chemotherapies in relapsed/refractory setting was observed in later lines, pointing to a high level of unmet need in this population.