Opinion
Video
Guidelines vs. Real Life in mCRC: Success Isn't ‘One Size Fits All’
Panelists discuss how endpoint prioritization in late-line metastatic colorectal cancer therapy differs between providers and patients, with pharmacists focusing primarily on progression-free survival and quality of life since patients frequently ask about living long enough to reach specific life events rather than overall survival statistics, while oncologists balance survival importance with comfort using regimens that have robust response rates and good quality of life even without level-one survival evidence, emphasizing that future research must be patient-centered by incorporating patient advocates and understanding what patients truly value most, as demonstrated by the disconnect between clinician focus on recurrence risk versus patient concerns about ostomy outcomes in rectal cancer, and requiring multidisciplinary approaches to staying current with evolving data through journal clubs, professional organization memberships, and increasingly social media platforms as starting points for identifying relevant clinical developments.
From a pharmacy perspective, progression-free survival and quality of life emerge as the most prioritized endpoints when evaluating late-line therapy populations. Patients and their family members frequently approach pharmacists with specific goals, such as surviving long enough to reach important life events or milestones. These conversations reveal that patients often prioritize feeling well during treatment over absolute survival duration, especially when they have experienced significant toxicity from previous regimens. The focus shifts from theoretical overall survival benefits to practical considerations of maintaining functionality and comfort while achieving disease stabilization for meaningful periods.
Oncologists similarly prioritize survival outcomes but acknowledge that overall survival is not always the definitive endpoint for treatment selection in late-line settings. While survival data remains highly important, clinicians are comfortable recommending regimens that may lack level-one evidence for survival improvement over competitors if they demonstrate robust response rates and favorable quality of life profiles. This pragmatic approach recognizes that in advanced disease stages, the balance between efficacy and tolerability becomes increasingly crucial for patient acceptance and treatment continuation.
The real-world application of treatment guidelines requires flexibility in endpoint prioritization based on individual patient circumstances and goals. Some patients explicitly ask about life expectancy, necessitating direct conversations about overall survival, while others focus primarily on maintaining quality of life during their remaining time. This patient-centered approach acknowledges that "success" in late-line therapy cannot be measured by a single metric but must incorporate multiple endpoints including progression-free survival, quality of life, and overall survival in a personalized framework that aligns with each patient's values and treatment objectives. The clinical challenge lies in balancing evidence-based recommendations with individual patient preferences and realistic treatment goals.
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