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Background: The optimal therapeutic strategy for metastatic colorectal cancer patients is still a matter of debate. There are no prognostic variables indicating how many lines individual patients ought to receive, and whether later lines could be effective even when earlier ones were not., Patients and Methods: We retrospectively collected data from 420 consecutive patients with metastatic colorectal cancer at our institution, describing the proportion of patients who received second or later lines of therapy and the chance of a line of treatment being active when the previous line was not. For each line of treatment, we defined clinical benefit as the probability of not having had evidence of disease progression 6 months after the start of chemotherapy., Results: Of the 373 patients with disease progression after first-line chemotherapy (1L), 277 received a second line (2L) (probability of being submitted to a 2L (P(2L)) = 74.3%): 143 (63.3%) of 226 received a 3L (P(3L)), and 56 (45.9%) of 122 were submitted to a 4L (P(4L)). Joint probabilities were: 2L 74.3%, 3L 47.0%, and 4L 21.6%. A total of 298 (71.5%) of 417 patients had a clinical benefit with 1L; 134 (48.6%) of 276 with 2L; 50 (35.2%) of 142 with 3L; and 12 (25.0%) of 48 with 4L. Taking all these data together, 31% of the patients who experienced early progression at 1L had the chance to have a clinical benefit with any further lines., Conclusion: Our study demonstrated that of 4 patients submitted to a 1L, about 3 will receive a 2L, about 2 a 3L, and nearly 1 a 4L. Later lines could be beneficial even though earlier ones were not., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Research biopsies are an increasingly important component of clinical trials, but there are concerns that biopsies may deter patients from participating in research., Patients and Methods: Patients participating in a single-center study investigating the feasibility of molecular profiling in advanced gastrointestinal cancers were asked to complete a questionnaire regarding their reasons for consenting/declining optional research biopsies and blood samples. These samples were mainly for exploratory translational research and were unlikely to influence patients' treatment., Results: One hundred ninety-six (88%) of the 222 patients registered in the study completed the questionnaire. One hundred twenty-six patients (64%) stated they consented to a biopsy and 180 patients (92%) to blood sample collection. Male patients (P = .033) and patients with a good performance status (PS) were more willing to consent to a biopsy (79% for PS 0, 63% for PS 1, 43% for PS 2; P = .012). Eighty-eight patients (70%) who consented to a biopsy gave an altruistic reason (eg, to help research and/or others) as a reason why they consented. Only 8 patients (6%) consented solely because they believed it might influence their treatment. Reasons for declining biopsies included a wish to avoid additional procedures (n = 18; 29%) and previous unpleasant biopsy experiences (n = 9; 15%)., Conclusion: Many patients with advanced gastrointestinal cancer appear willing to undergo biopsies for exploratory research purposes. In our study, patients who consented to a biopsy mainly did so for altruistic reasons and/or a wish to contribute to scientific research., (Copyright © 2016 Elsevier Inc. All rights reserved.)