Few patients 75 years of age and older participate in clinical trials, thus whether adjuvant chemotherapy for stage III colon cancer (CC) benefits this group is unknown.
A total of 5,489 patients ≥ 75 years of age with resected stage III CC, diagnosed between 2004 and 2007, were selected from four data sets containing demographic, stage, treatment, and survival information. These data sets included SEER-Medicare, a linkage between the New York State Cancer Registry (NYSCR) and its Medicare programs, and prospective cohort studies Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) and the National Comprehensive Cancer Network. Data sets were analyzed in parallel using covariate adjusted and propensity score (PS) matched proportional hazards models to evaluate the effect of treatment on survival. PS trimming was used to mitigate the effects of selection bias.
Use of adjuvant therapy declined with age and comorbidity. Chemotherapy receipt was associated with a survival benefit of comparable magnitude to clinical trials results (SEER-Medicare PS-matched mortality, hazard ratio [HR], 0.60; 95% CI, 0.53 to 0.68). The incremental benefit of oxaliplatin over non-oxaliplatin-containing regimens was also of similar magnitude to clinical trial results (SEER-Medicare, HR, 0.84; 95% CI, 0.69 to 1.04; NYSCR-Medicare, HR, 0.82, 95% CI, 0.51 to 1.33) in two of three examined data sources. However, statistical significance was inconsistent. The beneficial effect of chemotherapy and oxaliplatin did not seem solely attributable to confounding.
The noninvestigational experience suggests patients with stage III CC ≥ 75 years of age may anticipate a survival benefit from adjuvant chemotherapy. Oxaliplatin offers no more than a small incremental benefit. Use of adjuvant chemotherapy after the age of 75 years merits consideration in discussions that weigh individual risks and preferences.
"When treating elderly patients with rectal cancer, it is vital to determine how aggressively to treat, so that the costs and risks of the treatment will not outweigh the short-term benefits from treatment of the cancer. Recent studies have confirmed the survival benefit of adjuvant chemotherapy in elderly patients (≥75 years) with resected colon cancer
. However, the value of chemoradiotherapy (CRT) or radiotherapy (RT) in elderly patients with rectal cancer is still controversial. "
[Show abstract][Hide abstract] ABSTRACT: Purpose
To assess the safety and outcomes of radiotherapy (RT) or chemoradiotherapy (CRT) in elderly patients (≥70) with rectal cancer.
Elderly patients aged 70 and older with rectal cancer, who were treated with RT or CRT at a single institution, were retrospectively analyzed. Performance status (KPS and ECOG score) and comorbidity (Charlson comorbidity index) were calculated, and their correlation with treatment toxicity and overall survival were studied. Risk factors for overall survival were investigated using univariate and multivariate survival analysis.
A total of 126 patients with locally advanced disease, local recurrence or synchronous metastasis were included, with a 3-year OS rate of 48.1%. Scheduled dosage of radiation was delivered to 69% of patients. Grade 3 toxicities occurred more often in patients treated with CRT versus RT. The occurrence of grade 3 toxicities was not related to KPS score, ECOG score, number of comorbidities, and Charlson score. Multivariate analysis found that only age and Charlson score were independent prognostic factors for predicting patients’ 3-year OS. The 3-year OS rate was significantly higher in patients with Charlson score <4 vs Charlson score ≥4 (71.1% vs. 26.4%, P=0.0003).
Although toxicities may be significant, elderly patients with rectal cancer of varied stages can be safely treated with RT or CRT with careful monitoring and frequent modification of treatment. Except for patients’ age, Charlson comorbidity index may be helpful in assessing patients’ outcomes in elderly patients with rectal cancer.
[Show abstract][Hide abstract] ABSTRACT: Le risque de récidive d’un cancer du côlon de stade III justifie la prescription d’une chimiothérapie adjuvante qui a fait la preuve de son bénéfice dans cette indication. Le standard est une chimiothérapie selon le schéma FOLFOX pendant 6 mois. En cas de cancer de stade II, le bénéfice d’une chimiothérapie adjuvante est plus modeste et de ce fait n’est pas un standard, mais il existe un consensus pour la proposer en cas de facteurs de mauvais pronostic. Le bon pronostic des cancers du côlon de phénotype moléculaire MSI (microsatellite instability) est actuellement un élément décisionnel pour ne pas proposer de traitement adjuvant en cas de cancer du côlon de stade II de phénotype MSI. Les thérapies ciblées (bévacizumab et cétuximab), qui ont fait la preuve de leur efficacité en situation métastatique, n’apportent pas de bénéfice en situation adjuvante. Les enjeux à venir seront de déterminer de nouveaux facteurs prédictifs et/ou pronostiques, notamment moléculaires, permettant de personnaliser au mieux l’administration d’un traitement adjuvant en termes d’efficacité et de tolérance. Chez les patients âgés, le bénéfice d’une chimiothérapie adjuvante est sujet à discussion.
[Show abstract][Hide abstract] ABSTRACT: Colorectal cancer is the third commonest cancer and second commonest cancer killer in the USA. With a median age at diagnosis of 72 years, it largely affects the elderly population. However, there is a lack of objective data with which to answer clinically relevant questions regarding adjuvant therapy in the geriatric patient population because mainly younger patients are enrolled in clinical trials. Elderly patients are undertreated in the adjuvant setting owing to multiple factors, including physician decision and patient preference. Older patients have different tumor biology, physiologic factors, and social situations to consider in comparison with younger patients. Thus, geriatric patients require more thorough assessment of their functional status and existing medical conditions as they are at risk of increased toxicities from chemotherapy and their ongoing treatment requires vigilance. Elderly patients do benefit from adjuvant chemotherapy, although subgroup analyses show that many do not derive incremental benefit from the addition of oxaliplatin to 5-fluorouracil therapy.
Current Colorectal Cancer Reports 09/2013; 9(3). DOI:10.1007/s11888-013-0175-4
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