5PSQ-167 Analysis of firstline treatment in the elderly with metastatic colorectal cancer

Colorectal cancer (CRC) is one of the main causes of cancer death in the elderly. The older patients constitute a heterogeneous group in terms of functional status, comorbidities, and aging-related conditions. Therefore, therapeutic decisions need to be individualized. Additionally, a higher toxicity risk comes from the fact that pharmacokinetics and pharmacodynamics of the drugs as well as the tissue tolerance can be altered with aging. Although the chemotherapy efficacy in metastatic colorectal cancer (mCRC) is similar for older and young patients, more toxicity is presented in the elderly. While the mono-chemotherapy provides the same benefit for young and older patients, doublets front-line chemotherapy improves progression-free survival (PFS) but not overall survival (OS) in the elderly. Furthermore, the benefit of the addition of bevacizumab to chemotherapy in older patients has been shown in several clinical trials, while the clinical data for the benefit of anti-epidermal growth factor antibodies are scarcer. Immunocheckpoint inhibitors could be an appropriate option for patients with microsatellite instability (MSI) tumors. A prior geriatric assessment is required before deciding the type of treatment in order to offer the best therapeutic option.

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

British Journal of Cancer ◽

10.1038/sj.bjc.6601807 ◽

2004 ◽

Vol 90 (10) ◽

pp. 2051-2052

Author(s):

T Aparicio ◽

E Mitry ◽

J Ezenfis ◽

S Dominguez

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

The Elderly

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

British Journal of Cancer ◽

10.1038/sj.bjc.6601805 ◽

2004 ◽

Vol 90 (10) ◽

pp. 2050-2051 ◽

Cited By ~ 1

Author(s):

C Alliot ◽

M Barrios

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

The Elderly

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Bevacizumab in the first-line treatment of elderly patients with metastatic colorectal cancer: Mature results from a large community-based observational study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.566 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 566-566 ◽

Cited By ~ 1

Author(s):

Ralf Hofheinz ◽

Wilfried Grothe ◽

Dirk Tummes ◽

Manfred Kindler ◽

Volker Petersen ◽

...

Keyword(s):

Colorectal Cancer ◽

Observational Study ◽

Metastatic Colorectal Cancer ◽

Performance Status ◽

Progression Free Survival ◽

The Elderly ◽

Line Treatment ◽

First Line ◽

Eligibility Criteria ◽

Organ Site

566 Background: In most patients (pts) with metastatic colorectal cancer, a 3-drug combination of a fluoropyrimidine, oxaliplatin (ox) or irinotecan (iri), and a monoclonal antibody is considered standard 1st-line treatment. However, in elderly pts this choice remains controversial. After registration of bevacizumab (bev) in Germany in 2005, this observational study was initiated in pts receiving bev with various first-line chemotherapy (CT) regimens to evaluate the disease profile and efficacy of bev in patients with metastatic colorectal cancer. Methods: Eligibility criteria focused on M1 disease without prior palliative CT. The choice of CT regimen was at the physician’s discretion. Predefined efficacy endpoints were: response rate (RR), progression-free survival (PFS) and overall survival (OS). Pts were followed for up to 6 years (y). Two pt subgroups were analyzed: ≥70 y and ≥75 y; the ≥75 y group is the focus of this abstract. Results: 1777 eligible pts were enrolled at 261 sites from Jan 2005 to June 2009, 206 (12%) of whom were aged ≥75 y. These elderly pts did not differ greatly vs younger pts in time from initial diagnosis or time to first relapse, pT, pN and M stage, site of metastasis, grading, CEA, WBC, blood pressure, or prior adjuvant therapy. However, fewer elderly pts had >1 involved organ site (28% of pts ≥75 y vs. 32% of pts ≥70 y) and elderly pts had significantly poorer performance status (ECOG 0 in 29% of pts ≥75 y vs. 39% of pts ≥70 y). Bev treatment duration was similar in elderly and younger pts, but differences in CT usage were observed (Table). Response and survival outcomes were significantly worse in those aged ≥75 y. Conclusions: Bev-based treatment combinations can be used successfully in pts aged ≥75 y. However, PFS and OS are significantly shorter in pts aged ≥75 y vs younger pts, probably because of greater comorbidity and possibly because of less intensive treatment in the elderly. [Table: see text]

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A prospective study of XELOX plus bevacizumab as first-line therapy in Japanese patients with metastatic colorectal cancer (KSCC0902).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.583 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 583-583

Author(s):

Masaaki Takeuchi ◽

Yutaka Ogata ◽

Takaho Tanaka ◽

Atsushi Kaibara ◽

Yasunori Emi ◽

...

Keyword(s):

Colorectal Cancer ◽

Clinical Practice ◽

Prospective Study ◽

Metastatic Colorectal Cancer ◽

Response Rate ◽

Objective Response ◽

The Elderly ◽

Tolerability Profile ◽

First Line ◽

Grade 3

583 Background: XELOX plus bevacizumab (Bev) is one of the standard therapies for metastatic colorectal cancer (mCRC). However there was no clinical practice date in Japan. This study was designed to evaluate the efficacy and safety of XELOX plus Bev in the clinical practice in Japanese mCRC patients (pts) including the elderly. Methods: The study design was multicenter, single-arm, open-label prospective study. The major inclusion criteria were previously untreated mCRC; presence of measurable lesions; age 20 years; ECOG performance status (PS) 0–2; and adequate organ function. Pts received Bev 7.5 mg/kg d1 and XELOX (oxaliplatin 130 mg/m2 d1 plus capecitabine 1,000 mg/m2 bid d1-14) q3w. This schedule was repeated until unacceptable toxicity or disease progression occurred. The primary endpoint was RECIST-confirmed objective response rate (ORR). A sample size of 41 was planned for a threshold ORR of 30% and expected value of 50%, with one-sided alpha of 0.05 and beta of approximately 0.2. Results: Of the 47 pts (male/female, 29/18; median age, 66 years (range 38-81); PS 0/1/2, 40/5/2) enrolled from May 2010 to Mar 2011. One patient did not fulfill the eligibility criteria. 46 pts were assessed for response; CR 1 pts, PR 23 pts, SD 15 pts, PD 2 pts, and NE 5 pts. The confirmed ORR was 52.2% (90% CI, 39.2-65.0%). The response rate across all time points without confirmation was 67.4% (95% CI, 52.0-80.5%). Median PFS and OS have not yet been reached. The most common grade 3/4 adverse events were anorexia 12.8%, neutropenia 10.6%, fatigue 8.5%, hypertension 4.3%, thrombocytopenia 4.3%, hand-foot syndrome 2.1% and bleeding 2.1%. Grade 3/4 peripheral neuropathy did not occur. Conclusions: First-line treatment of XELOX + Bev showed a promising response rate and an acceptable tolerability profile in the clinical practice in Japanese mCRC pts including the elderly. Clinical trial information: UMIN000003915.

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