A new study based on the ARCAD database—supported by A.R.CA.D, a member of DiCE—has shed light on how both patient and tumour characteristics evolve across treatment lines in metastatic colorectal cancer (mCRC). The findings, recently published and shared via the European Society for Medical Oncology (ESMO), raise important questions about how clinical trials reflect the real-world patient population.

As patients progress from first- to second- and third-line therapies, the study found a growing complexity in disease patterns. Lung and lymph node metastases became more frequent, and fewer patients moved on to later treatment stages—between 30% and 50% stopped after first- or second-line therapy.

The researchers also found that patients included in later-line clinical trials tend to be younger and fitter, often with left-sided or rectal tumours. Meanwhile, patients with more aggressive or complex disease—such as those with right-sided tumours, BRAF mutations, or dMMR—were underrepresented, even though these groups typically face worse outcomes.

These findings suggest that results from clinical trials may not always reflect the full diversity of real-life patients with mCRC. Treatment decisions should therefore consider the individual patient’s characteristics and treatment history, rather than being based solely on trial data.

Thanks to the ARCAD database and the commitment of organisations like A.R.CA.D, we now have a clearer picture of how mCRC evolves and how future trials can be made more inclusive and representative.

At DiCE, we remain committed to promoting equitable access to trials and personalised care for all patients with digestive cancers.

Further information, visit: https://ascopubs.org/doi/10.1200/JCO-24-01968

Author:

Marianna Vitaloni