Oxaliplatin- or irinotecan-based chemotherapy for metastatic colorectal cancer in the elderly.

Service d'Hépato-Gastroentérologie, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, AP-HP, Paris 75018, France.
British Journal of Cancer (Impact Factor: 4.82). 11/2003; 89(8):1439-44. DOI: 10.1038/sj.bjc.6601310
Source: PubMed

ABSTRACT The tolerance and efficacy of oxaliplatin and irinotecan for metastatic colorectal cancer are unknown in elderly patients. Methods. All consecutive patients over 74 years treated with oxaliplatin or irinotecan for metastatic colorectal cancer were enrolled. The tumour response was assessed every 2-3 months and toxicity was collected at each cycle according to World Health Organisation criteria. A total of 66 patients were enrolled from 12 centres. The median age was 78 years (range, 75-88 years); 39 patients had no severe comorbidity according to the Charlson score. In total, 44 and 22 patients received oxaliplatin or irinotecan, respectively, in combination with 5-fluororuracil+/-folinic acid or raltitrexed in 64 patients. A total of 545 chemotherapy cycles were administered in first (41%), second (51%) or third line (8%). A dose reduction occurred in 190 cycles (35%). Complete response, partial response and stabilisation occurred in 1.5, 20 and 47% of patients, respectively. The median time to progression and overall survival were 6.8 and 11.2 months in first line and 6.3 and 11.6 months in second line, respectively. Grade 3 and 4 toxicity occurred in 42% of patients: neutropenia 17%, diarrhoea 15%, neuropathy 11%, nausea and vomiting 8% and thrombopenia 6%. There was no treatment-related death. In selected elderly patients, chemotherapy with oxaliplatin or irinotecan is feasible with manageable toxicity.

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    ABSTRACT: PurposeThe incidence of colorectal cancer in elderly patients has increased markedly in China. This study was aimed to analyze the efficacy and tolerance of oxaliplatin-based chemotherapy in elderly patients with advanced colorectal cancer.Methods We carried out a retrospective analysis using date of 41 advanced colorectal cancer patients who received oxaliplatin-based chemotherapy with an age of 65 years or above.ResultsAmong 41 enrolled patients, 24 received XELOX and 17 received FOLFOX. The overall response rate was 36.6%, the disease control rate was 73.2%, including 15 partial response, 15 stable disease and 11 progressive disease. The median progression-free survival and median overall survival was 7.5 months (95%CI: 6.54 ∼ 8.46 months) and 23.0 months (95%CI: 15.35 ∼ 30.64 months) respectively. Patients with lower CEA level (CEA ≤ 5 ng/ml) before treatment get a longer median progression-free survival than other patients (7.5 months vs 7.0 months; P = 0.026), but the overall survival differences did not reach statistical significance. The toxicity was tolerable, the main 3 or 4 grade hematological and non-hematological toxicities were neutropenia (n = 6,14.6%) and diarrhea (n = 2,4.8%). No treatment-related death was found.Conclusions The oxaliplatin-based chemotherapy was efficacy and safety in elderly patients with advanced colorectal cancer, and should be considered as an effective treatment for Chinese elderly patients.
    Biomedicine & Aging Pathology. 01/2013; 3(1):1–6.
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    ABSTRACT: Background: Unlike for fit elderly metastatic colorectal cancer (mCRC) patients, general approaches to initial treatment for the frail older mCRC patients are not clear. Our aim was to evaluate the efficiency and safety of first-line single-agent treatment in one such group. Materials and Methods: We retrospectively evaluated mCRC patients aged 70 or older with an Eastern Cooperative Oncology Group performance score of 2. They had no prior treatment and underwent first-line single-agent capecitabine or other monotherapies until disease progression or unacceptable toxicity. Results: Thirty-six patients were included. Most (n:28, 77.8%) were treated with capecitabine. One patient achieved a complete response and 5 patients had a partial response for an overall response rate of 16.6%. Twelve patients (33.3%) remained stable. Median progression free survival was 5 months (confidence interval (CI), %; 3.59-6.40) and median overall survival was 10 months (95 CI%; 8.1-11.8). Grade 3-4 toxicity was found in 6 patients (16.6%). Febrile neutropenia was not observed and there were no toxicity-associated deaths. Conclusions: Capecitabine is a safe chemotherapeutic agent with moderate activity for first-line treatment of older metastatic colorectal cancer patients with limited performance status.
    Asian Pacific journal of cancer prevention: APJCP 04/2014; 15(7):3157-61. · 1.50 Impact Factor
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    ABSTRACT: Despite many recent advances in the treatment of metastatic colorectal cancer (mCRC) and corresponding improvements in patient survival, most of the pivotal trials have involved fit, young patients. Consequently, it is unclear whether efficacy and safety profiles from these large randomized trials are applicable to patients older than 70 years of age, who account for more than half of those with mCRC. Most of the conclusions regarding chemotherapy for elderly mCRC patients are derived from combined or subgroup analyses from large studies in which elderly patients are typically defined as those more than 65 or 70 years of age. In general, it was concluded that, as with young patients, systemic chemotherapy could be beneficial for these elderly patients also, with tolerable adverse events. Nonetheless, it was subsequently determined that serious adverse events occurred more frequently in elderly patients and that immediate intensive chemotherapy did not always result in better overall survival for this group. In patients scheduled for capecitabine, previous estimation of renal function and careful administration of the drug are necessary; however, contrary to expectations, the quality of life is not better than that achieved with 5-fluorouracil. Another therapeutic option is immediate doublet chemotherapy, but for elderly patients, a stop-and-go strategy or chemotherapy-free intervals should be considered. Targeted agents, including bevacizumab, cetuximab, and panitumumab, have resulted in outcomes no inferior for older than for younger patients, but they require further investigation to optimize their use. The variable findings obtained for elderly patients emphasize the need for a definition of “elderly” that takes into account not only chronological age, but also physiological age, socioeconomic status, and the results of objective tools such as comprehensive geriatric assessment.
    Current Colorectal Cancer Reports 09/2013; 9(3).

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