Real-World Comparative Outcomes of Chemo-Immunotherapy Versus Chemotherapy in Colon Cancer: A Multi-Center Retrospective Cohort Study

Document Type

Conference Proceeding

Publication Date

6-1-2025

Publication Title

Journal of Clinical Oncology

Abstract

Background: Immunotherapy and chemotherapy are key treatments for metastatic colon cancer, but their comparative effects on survival and adverse events remain unclear, warranting further investigation. Methods: This retrospective study used the TriNetX database (January 2017–December 2022) to evaluate patients with stage II-IV colon cancer. Outcomes were compared between patients receiving a combination of chemotherapy and immune checkpoint inhibitors with Ipilimumab, Pembrolizumab, Nivolumab, and Atezolizumab (chemoimmunotherapy), and those treated with chemotherapy alone (5-FU or capecitabine). Propensity score matching ensured balanced cohorts. Results: After matching, each cohort was reduced to 171 patients, achieving balance in demographics such as age (mean 64.9 ± 14.1 vs. 66 ± 13.5 years), sex (51.46% male vs. 49.70% male), ethnicity (59.06% vs. 55.56% non-Hispanic), and White race (63.74% vs. 67.25%). The median follow-up was shorter in the chemoimmunotherapy group (498 days; IQR: 944 days) compared to the chemotherapy group (772 days; IQR: 734 days). Median overall survival (OS) was significantly shorter in the chemo-immunotherapy group (648 days) compared to the chemotherapy group, with survival probabilities at the end of the time window of 40.75% and 58.94%, respectively. The hazard ratio (HR) for survival was 1.883 (95% CI: 1.356–2.616, p = 0.0001), indicating a significantly higher risk of mortality in the chemo-immunotherapy group compared to the chemotherapy group. The risk of Major Adverse Cardiovascular Events (MACE) was similar between the chemo-immunotherapy and chemotherapy groups (HR: 0.889, 95% CI: 0.608–1.299, p = 0.9209). The risk of Major Adverse Kidney Events (MAKE) was comparable between the groups (HR: 1.298, 95% CI: 0.843–1.998, p = 0.8126). The risk of liver metastases was higher in the chemo-immunotherapy group compared to the chemotherapy group (HR: 1.548, 95% CI: 1.127–2.126, p = 0.2519). The risk of gastrointestinal (GI) bleeding was similar between the two groups (HR: 1.537, 95% CI: 0.727–3.253, p = 0.7349). Conclusions: Chemo-immunotherapy in metastatic colon cancer showed a shorter overall survival compared to chemotherapy alone, with no significant differences in MACE, MAKE, liver metastases, or GI bleeding risks.

Volume

43

Issue

16 Suppl

First Page

e15579

Comments

2025 ASCO (American Society of Clinical Oncology) Annual Meeting, May 30 - June 3, 2025, Chicago, IL

Last Page

e15579

DOI

10.1200/JCO.2025.43.16_suppl.e15579

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