Cetuximab use in metastatic colorectal cancer at Princess Alexandra Hospital: streamlined analysis using electronic medical record data (#310)
Information systems are often used in clinical practice as the standard method of patient record management. Using the vast amounts of automatically collected data to produce clinically relevant service analyses is desirable as it can be done more quickly and accurately than manual chart audits. This project aimed to analyse data from the electronic prescribing system / medical record (Charm®) on cetuximab use in metastatic colorectal cancer (mCRC) patients at Princess Alexandra Hospital (PAH) and to compare our data to evidence-based guidelines.
Data for all patients assigned to cetuximab therapy during the period 01/09/2009 to 30/06/2013 was retrospectively extracted. Extracted data included patient characteristics (age, sex, weight, BSA and BMI) and treatment characteristics (treatment protocol, cetuximab dose, treatment dates and vital status). Descriptive statistical analyses were performed.
Fifty-two cetuximab-containing protocols for mCRC were planned in the study period and 33 patients received at least one cetuximab dose. Median patient age was 64.5yrs, and 62% were male. Median patient BSA was 1.91 m2 and BMI was 27.05 kg/m2. Patients were distributed into five different cetuximab-containing protocols, generally as second or third-line treatment, with most prescribed weekly cetuximab with or without irinotecan. Median cetuximab maintenance dose was 477.5mg (weekly regimens). Median treatment length was 56 days (weekly cetuximab) and 42 days (biweekly cetuximab). Median survival was 6.2 months from first cetuximab dose.
Cetuximab use in mCRC at PAH is similar to evidence-based guidelines, based on patient and treatment characteristics. The median survival was slightly less than that shown in similar published larger clinical trials (6.9 to 9.2 months)1-4, most likely explained by the different study size and methodology (retrospective audit vs controlled prospective trial). Importantly, the data extraction and analysis phase of the project was able to be completed within a matter of days illustrating a very achievable method of measuring service-wide patient care against current best practice.
- Jonker DJ, O'Callaghan CJ, Karapetis CS, Zalcberg JR, Tu D, Au H, et al. Cetuximab for the treatment of colorectal cancer. The New England Journal of Medicine. 2007;357(20):2040-8.
- Karapetis CS, Khambata-Ford S, Jonker DJ, O'Callaghan CJ, Tu D, Tebbutt NC, et al. K-ras mutations and benefit from cetuximab in advanced colorectal cancer. The New England Journal of Medicine. 2008;359(17):1757-65.
- Wilke H, Glynne-Jones R, Thaler J, Adenis A, Preusser P, Aguilar EA, et al. Cetuximab PLUS Irinotecan in heavily pretreated metastatic colorectal cancer progressing on irinotecan: MABEL study. American Society of Clinical Oncology. 2008;26(33):5335-43.
- Cunningham D, Humblet Y, Siena S, Khayat D, Bleiberg H, Santoro A, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. The New England Journal of Medicine. 2004;351(4):337-45.