The FIRE-3 investigators did not report the use of salvage treatments, and this may be confounding the results, according to Richard Goldberg, MD, who discussed the paper at an ASCO press briefing. Dr. Goldberg is Professor of Medicine at The Ohio State University, Columbus.

“The study shows a survival advantage, and the investigators are a very reputable group, so I believe their data. But I believe that within the data there are stories we have yet to understand,” he said.

“Today because of multiple effective drug treatments, treating advanced colon cancer is analogous to a baseball game in which we have many innings. Perhaps the first inning is the most important, but it is likely that all the innings contributed to the contest’s final outcome. In this case, different lines of therapy are analogous to different innings and all likely contributed to the overall survival,” Dr. Goldberg suggested.

He advised the investigators to revisit the data and examine all subsequent lines of treatment. “This could help explain a finding that does seem a bit anomalous,” he commented. ■

Disclosure: Dr. Goldberg has served on data monitoring committees for Eli Lilly and Pfizer.