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O’Donnell CDJ, Hubbard J, Jin Z. Updates on the Management of Colorectal Cancer in Older Adults. Cancers (Basel) 2024; 16:1820. [PMID: 38791899 PMCID: PMC11120096 DOI: 10.3390/cancers16101820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Colorectal cancer (CRC) poses a significant global health challenge. Notably, the risk of CRC escalates with age, with the majority of cases occurring in those over the age of 65. Despite recent progress in tailoring treatments for early and advanced CRC, there is a lack of prospective data to guide the management of older patients, who are frequently underrepresented in clinical trials. This article reviews the contemporary landscape of managing older individuals with CRC, highlighting recent advancements and persisting challenges. The role of comprehensive geriatric assessment is explored. Opportunities for treatment escalation/de-escalation, with consideration of the older adult's fitness level. are reviewed in the neoadjuvant, surgical, adjuvant, and metastatic settings of colon and rectal cancers. Immunotherapy is shown to be an effective treatment option in older adults who have CRC with microsatellite instability. Promising new technologies such as circulating tumor DNA and recent phase III trials adding later-line systemic therapy options are discussed. Clinical recommendations based on the data available are summarized. We conclude that deliberate efforts to include older individuals in future colorectal cancer trials are essential to better guide the management of these patients in this rapidly evolving field.
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Affiliation(s)
- Conor D. J. O’Donnell
- Mayo Clinic School of Graduate Education, Mayo Clinic College of Medicine and Science, Mayo Building, Rochester, MN 55905, USA;
| | - Joleen Hubbard
- Allina Health Cancer Institute, Minneapolis, MN 55407, USA
| | - Zhaohui Jin
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Pécsi B, Mangel LC. The Real-Life Impact of mFOLFIRI-Based Chemotherapies on Elderly Patients-Should We Let It or Leave It? Cancers (Basel) 2023; 15:5146. [PMID: 37958320 PMCID: PMC10649926 DOI: 10.3390/cancers15215146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
AIM The oncologic treatment of elderly patients is going on with a lack of evidence due to their underrepresentation in clinical trials. Many data suggest that certain groups of elderly patients, like their younger counterparts, may benefit from the systemic treatment of their metastatic colorectal tumors (mCRC). METHOD We performed retrospective data analysis to investigate the clinical course of care and clinical outcomes of 515 patients who received first-line mFOLFIRI-based chemotherapy for mCRC between 1 January 2013 and 31 December 2018 at the Institute of Oncotherapy of the University of Pécs, focusing on a comparison of patients over and under 70 years of age, defined as the cut-off value. RESULTS 28.7% of the 515 patients were 70 years old and older (median age 73.5 years). Compared to the data of the elderly patients, the younger group (median age 61.1 years) had a performance status that was significantly better (average ECOG 1.07 vs. 0.83, p < 0.0001), and significantly more patients received molecularly targeted agents (MTA) (21.6% vs. 51.8%, p < 0.0001); nevertheless, mPFS (241 vs. 285 days, p = 0.3960) and mOS (610 vs. 698 days, p = 0.6305) results did not differ significantly. Considering the 1y PFS OR and the 2ys OS OR values (0.94 [95%CI 0.63-1.41] and 0.72 [95%CI 0.47-1.09], respectively), only a non-significant trend was observed in OS favouring the younger population. Additional analysis of our data proved that the survival in patients over 70 years was positively affected by the addition of MTAs to the doublet chemotherapies, and the reasonable modifications/reductions in dose intensity and the addition of local interventions had similar positive effects as observed in the younger patients' group. CONCLUSIONS Age stratification of mCRC patients is not professionally justified. Patients over 70 years of age with good performance status and controlled co-morbidities benefit from systemic therapy, its modifications and local treatment to the same extent as younger patients. With the increasing incidence of age-related cancers due to the rising average lifespan, prospective randomised clinical trials are needed to determine the real value of systemic therapy in the elderly and the rational, objective methods of patient selection.
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Affiliation(s)
- Balázs Pécsi
- Institute of Oncotherapy, Medical School and Clinical Center, University of Pécs, 7624 Pécs, Hungary;
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Gabbani M, Giorgi C, Napoli G, Tebano U, Perrone MS, Missiroli S, Berretta M, Mandarà M, Zaninelli M, Luca N, Grigolato D, Muraro M, Rinaldi G, Pinton P, Fiorica F. Outcomes of Locally Advanced Rectal Cancer Patients Treated with Total Neoadjuvant Treatment: A Meta-Anaysis of Randomized Controlled Trials. Clin Colorectal Cancer 2022; 21:297-308. [PMID: 36210320 DOI: 10.1016/j.clcc.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND & AIMS Determining outcomes using the total neoadjuvant therapy (TNT) in patients with local advanced rectal cancer is important for stratifying patients according to expected outcomes in future studies in the era of treatment combination. The present meta-analysis estimated the pathological complete response, disease-free survival, and overall survival probabilities of rectal cancer patients and identified predictors of outcomes. METHODS Studies reporting pathological complete response rate and time-dependent outcomes (progression or death) after total neoadjuvant treatment of locally advanced rectal cancer (LARC) were identified in MEDLINE through January 2022. Three independent observers extracted data on patient populations and outcomes and combined the data using a distribution-free summary survival curve. The primary outcomes were actuarial probabilities of recurrence and survival. RESULTS Fourteen RCTs, including 18 TNT arms, met the inclusion criteria. The pooled estimate of pathological complete response (pCR) probability was 23.6%, with moderate heterogeneity between studies. The pooled estimates of actuarial disease-free survival rate were 70.6% at 3 years and 65.4% at 5 years. The pooled estimates of actuarial survival rates were 93% at 3 years and 81.6% at 5 years. In both these outcomes, heterogeneity between studies was highly significant. CONCLUSION This meta-analysis showed that Total Neoadjuvant Therapy is an optimal approach for LARC patients. The results provide a useful benchmark for future comparisons of the benefits of combinations of other drug families as target therapies or immunotherapies.
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Affiliation(s)
- Milena Gabbani
- Department of Radiation Oncology and Nuclear Medicine, Verona, Italy
| | - Carlotta Giorgi
- Dept. of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Giuseppe Napoli
- Department of Radiation Oncology and Nuclear Medicine, Verona, Italy
| | - Umberto Tebano
- Department of Radiation Oncology and Nuclear Medicine, Verona, Italy
| | - Maria Sole Perrone
- Dept. of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Sonia Missiroli
- Dept. of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Massimiliano Berretta
- Department of Clinical and Experimental Medicine, Policlinico "G. Martino" University of Messina, Messina, Italy
| | | | | | - Nicoletta Luca
- Department of Radiation Oncology and Nuclear Medicine, Verona, Italy
| | - Daniela Grigolato
- Department of Radiation Oncology and Nuclear Medicine, Verona, Italy
| | - Marco Muraro
- Department of Radiation Oncology and Nuclear Medicine, Verona, Italy
| | - Giulia Rinaldi
- Department of Radiation Oncology and Nuclear Medicine, Verona, Italy
| | - Paolo Pinton
- Dept. of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Francesco Fiorica
- Department of Radiation Oncology and Nuclear Medicine, Verona, Italy.
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Ren Y, Yuan B, Hou S, Sui Y, Yang T, Lv M, Zhou Y, Yu H, Li S, Peng H, Chang N, Liu Y. Delivery of RGD-modified liposome as a targeted colorectal carcinoma therapy and its autophagy mechanism. J Drug Target 2021; 29:863-874. [PMID: 33507113 DOI: 10.1080/1061186x.2021.1882469] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Liposomes are among the most extensively applied drug carriers due to their excellent biocompatibility, controllable size and ease of modification. In the present study, we prepared untargeted liposomes (LP) and targeting liposomes modified with Arg-Gly-Asp (RGD-LP), and Doxorubicin Hydrochloride (DOX) or fluorescent probe was loaded. RGD-LP/DOX was identified to be uniformly spherical in size 131.2 ± 2.7 nm. Based on flow cytometry analysis and the confocal laser scanning microscopy, RGD-LP had a higher uptake into HRT-18 colorectal cancer cells than LP. Further, in vivo imaging study further suggested that RGD-LP could significantly increase the liposome accumulation in the tumour tissues of the mice bearing subcutaneous tumours. By investigating the targeting mechanism of RGD-LP, we found that they entered the cell via macropinocytosis. When loaded with DOX, RGD-LP exerted stronger tumour growth inhibitory activity against tumours of colorectal carcinoma compared to LP. Moreover, RGD-LP induced autophagy. Therefore, RGD-LP have the potential to be applied as a targeted colorectal carcinoma therapy.
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Affiliation(s)
- Yachao Ren
- Department for a affiliation.Department of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Bingchuan Yuan
- Department for a affiliation.Department of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Shenghua Hou
- Department for a affiliation.Department of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Yilei Sui
- Department for a affiliation.Department of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Tinghui Yang
- Department for a affiliation.Department of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Meilin Lv
- Department for a affiliation.Department of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Yulong Zhou
- College of Animal Science and Technology, Heilongjiang Bayi Agricultural University, Daqing, China
| | - Hui Yu
- Department for a affiliation.Department of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Sen Li
- Department for a affiliation.Department of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Haisheng Peng
- Department for a affiliation.Department of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Naidan Chang
- Department for a affiliation.Department of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Yang Liu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
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Aparicio T, Canouï-Poitrine F, Caillet P, François E, Cudennec T, Carola E, Albrand G, Bouvier AM, Petri C, Couturier B, Phelip JM, Bengrine-Lefevre L, Paillaud E. Treatment guidelines of metastatic colorectal cancer in older patients from the French Society of Geriatric Oncology (SoFOG). Dig Liver Dis 2020; 52:493-505. [PMID: 32029404 DOI: 10.1016/j.dld.2019.12.145] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several guidelines dedicated to metastatic colorectal cancer (mCRC) are available. Since 2013 no recent guidelines are specifically dedicated to older patients and based on a systematic review. MATERIALS AND METHODS A multidisciplinary Task Force with digestive oncologists, geriatricians and methodologists from the SoFOG was formed in 2016 to update recommendations on medical treatment of mCRC based on a systematic review of publications from 2000 to 2018. Search strategy has followed a standardized protocol from the formulation of clinical questions and definition of a search algorithm to the selection of complete articles for recommendations. RESULTS The four selected key questions were: For which older patients with mCRC can we considered: (1) Any chemotherapy, (2) Mono or poly-chemotherapy, (3) Anti-angiogenic therapy, (4) Other targeted therapy. Main recommendations for older patients are: (1) Omission of chemotherapy should be discussed with a geriatrician for patients with severe comorbidities, advanced dementia, uncontrolled psychiatric disorder or severe loss of autonomy. (2) If tumor response is not the main aim, a mono-chemotherapy with 5-fluorouracil combined with bevacizumab is recommended as first-line. (3) For patients with symptoms related to metastases or with a planned metastasis ablation, a doublet chemotherapy combined with bevacizumab or anti-EGFR antibody in the context of a RAS wild type tumor is recommended as first-line. Preliminary data suggest that regorafenib may be used, in its registered indication, in patients under 80 with a performance status of 0 and no autonomy alterations and that trifluridine-tipiracil may be used with a tight supervising of hematological function.
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Affiliation(s)
- Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, AP-HP, University of Paris, Paris, France.
| | - Florence Canouï-Poitrine
- Clinical Epidemiology and Ageing Unit, Henri Mondor Hospital, APHP, EA 7376, CEpiA- IMRB, University of Paris-Est, Créteil, France
| | - Philippe Caillet
- Department of Geriatry, Georges Pompidou Hospital, APHP, University of Paris, Paris, France
| | - Eric François
- Department of Medical Oncology, Antoine-Lacassagne Center, University Côte d'Azur, Nice, France
| | - Tristan Cudennec
- Department of Geriatry, Ambroise Paré Hospital, APHP, University Versailles - Saint Quentin, Boulogne-Billancourt, France
| | - Elisabeth Carola
- Department of Medical Oncology, Public Sud de l'Oise Hospital, Creil, France
| | - Gilles Albrand
- Department of Geriatry, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, INSERM UMR1231 EPICAD University of Burgundy Franche Comté, Dijon, France
| | - Camille Petri
- Clinical Epidemiology and Ageing Unit, Henri Mondor Hospital, APHP, EA 7376, CEpiA- IMRB, University of Paris-Est, Créteil, France
| | - Bérengère Couturier
- Clinical Epidemiology and Ageing Unit, Henri Mondor Hospital, APHP, EA 7376, CEpiA- IMRB, University of Paris-Est, Créteil, France
| | - Jean-Marc Phelip
- Department of Gastroenterology and Digestive Oncology, Saint-Etienne Hospital, University Jean Monnet, Saint-Priest-en-Jarez, France
| | | | - Elena Paillaud
- Department of Geriatry, Georges Pompidou Hospital, APHP, University of Paris, Paris, France
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De Divitiis C, Nasti G, Montano M, Fisichella R, Iaffaioli RV, Berretta M. Prognostic and predictive response factors in colorectal cancer patients: Between hope and reality. World J Gastroenterol 2014; 20:15049-15059. [PMID: 25386053 PMCID: PMC4223238 DOI: 10.3748/wjg.v20.i41.15049] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/13/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the most commonly diagnosed cancers worldwide. It is the second leading cause of cancer death in Western Countries. In the last decade the survival of patients with metastatic CRC has improved dramatically. Due to the advent of new drugs (irinotecan and oxaliplatin) and target therapies (i.e., bevacizumab, cetuximab and panitumab), the median overall survival has risen from about 12 mo in the mid nineties to 30 mo recently. Many questions needing of right collocations and more clearness still exist regarding the prognostic factors and the predictive factors of response to therapy. Despite advances in dosing and scheduling of chemotherapy in both adjuvant and advanced settings, and a greater emphasis on early detection, the outlook still remains poor for most patients. Molecular analyses have shown that the natural history of all CRCs is not the same. Individual patients with same stage tumours may have different long term prognosis and response to therapy. In addition, some prognostic variables are likely to be more important than others. Here we review the role of prognostic factors and predictive factors according to the recently published English literature.
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First-line bevacizumab and capecitabine-oxaliplatin in elderly patients with mCRC: GEMCAD phase II BECOX study. Br J Cancer 2014; 111:241-8. [PMID: 24946000 PMCID: PMC4102952 DOI: 10.1038/bjc.2014.346] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/12/2014] [Accepted: 05/27/2014] [Indexed: 12/13/2022] Open
Abstract
Background: Subgroup analyses of clinical studies suggest that bevacizumab plus XELOX is effective and tolerable in elderly patients with metastatic colorectal cancer (mCRC). The prospective BECOX study examined the efficacy and safety of bevacizumab plus XELOX, followed by bevacizumab plus capecitabine in elderly patients with mCRC. Methods: Patients aged ⩾70 years with Eastern Cooperative Oncology Group performance status 0 out of 1 and confirmed mCRC were included. Patients received bevacizumab 7.5 mg kg−1 and oxaliplatin 130 mg m−2 on day 1, plus capecitabine 1000 mg m−2 bid orally on days 1–14 every 21 days; oxaliplatin was discontinued after 6 cycles. The primary end point was time to progression (TTP). Results: The intent-to-treat population comprised 68 patients (65% male, median age 76 years). Median TTP was 11.1 months; median overall survival was 20.4 months; overall response rate was 46%. Grade 3 or 4 adverse events included diarrhoea (18%) and asthenia (16%). Grade 3 or 4 adverse events of special interest for bevacizumab included deep-vein thrombosis (6%) and pulmonary embolism (4%). Conclusions: Bevacizumab plus XELOX was effective and well tolerated in elderly patients in the BECOX study. The adverse-event profile was similar to previous reports; no new safety concerns were identified. Fit elderly patients with mCRC should be considered for treatment with bevacizumab plus XELOX.
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De Felice F, Musio D, Izzo L, Pugliese F, Izzo P, Bolognese A, Tombolini V. Preoperative chemoradiotherapy in elderly patients with locally advanced rectal cancer. BIOMED RESEARCH INTERNATIONAL 2013; 2013:610786. [PMID: 24392453 PMCID: PMC3874365 DOI: 10.1155/2013/610786] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 12/04/2013] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the treatment tolerance and clinical outcomes in patients aged 70 and older with locally advanced rectal carcinoma treated with multimodality approach. METHODS AND MATERIALS We retrospectively analysed 20 consecutive elderly patients, with histologically proven rectal adenocarcinoma, staged T3-4, and/or node-positive tumour, who received chemoradiotherapy and proceeded to surgical approach. Performance status score and adult comorbidity evaluation-27 score were calculated, and their influence on treatment tolerance and clinical outcomes was analysed. RESULTS All patients completed programmed chemoradiotherapy treatment. Gastrointestinal toxicity was the most common acute side effects: proctitis in 70% of patients and diarrhoea in 55%, classified as Grade 3 in 3 patients only. Radiation dermatitis was reported in 7 patients (35%) and it was graded G3 in one patient. There was no haematological toxicity. Eighteen patients out of 20 underwent surgery. Sphincter preservation was assured in 13 patients. Comorbidity index was related to higher severe acute toxicity (P = 0.015) but no influenced treatment outcomes. CONCLUSION Treatment tolerance with combined modality is good in elderly patients. Due to age, no dose reduction for radiation therapy and chemotherapy should be considered.
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Affiliation(s)
- Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I “Sapienza” University of Rome, Viale Regina Elena 326, 00161 Rome, Italy
| | - Daniela Musio
- Department of Radiotherapy, Policlinico Umberto I “Sapienza” University of Rome, Viale Regina Elena 326, 00161 Rome, Italy
| | - Luciano Izzo
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I “Sapienza” University of Rome, Viale Regina Elena 326, 00161 Rome, Italy
| | - Federico Pugliese
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I “Sapienza” University of Rome, Viale Regina Elena 326, 00161 Rome, Italy
| | - Paolo Izzo
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I “Sapienza” University of Rome, Viale Regina Elena 326, 00161 Rome, Italy
| | - Antonio Bolognese
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I “Sapienza” University of Rome, Viale Regina Elena 326, 00161 Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I “Sapienza” University of Rome, Viale Regina Elena 326, 00161 Rome, Italy
- Spencer-Lorillard Foundation, Viale Regina Elena 262, 00161 Rome, Italy
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Cappellani A, Vita MD, Zanghì A, Cavallaro A, Piccolo G, Majorana M, Barbera G, Berretta M. Prognostic factors in elderly patients with breast cancer. BMC Surg 2013; 13 Suppl 2:S2. [PMID: 24268048 PMCID: PMC3851261 DOI: 10.1186/1471-2482-13-s2-s2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Breast cancer (BC) remains principally a disease of old ages; with 35-50% of cases occurring in women older than 65 years. Even mortality for cancer increases with aging: 19.7% between 65 and 74 years; 22.6% between 75 and 84 years; and 15.1% in 85 years or more. METHODS A search was performed on Medline, Embase, Scopus using the following Key words: Breast cancer, Breast neoplasms, Aged, Elder, Elderly, Eldest, Older, Survival analysis, Prognosis, Prognostic factors, Tumor markers, Biomarkers, Comorbidity, Geriatric assessment, Axilla, Axillary surgery. 3029 studies have been retrieved. Paper in which overall or disease free survival were not end points, or age class was not well defined, or the sample was too small, were excluded. At last 42 papers fulfilled the criteria. RESULTS AND DISCUSSION Lack of screening and delay in diagnosis may be responsible for the minor improvement in survival observed in elderly respect to younger breast cancer patients. Predictive factors are the same and must be assessed with the same attention reserved to younger women. CONCLUSIONS Most of elderly patient are fit to undergo standard treatment and can get the same benefits of younger women. Nevertheless it is possible that some older women with early breast cancer can be spared too aggressive treatments. Geriatric assessment and co-morbidities can affect the prognosis modifying surveillance, life expectancy and compliance to therapies. They can thus be useful to select the better treatment, either surgical or radio or hormone - or chemo-therapy.
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Affiliation(s)
- Alessandro Cappellani
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
| | - Maria Di Vita
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
| | - Antonio Zanghì
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
| | - Andrea Cavallaro
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
| | - Gaetano Piccolo
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
| | - Marcello Majorana
- Department of Radiology, Mediterranean Institute of Oncology, Viagrande, (CT), Italy
| | - Giuseppina Barbera
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
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Di Benedetto F, Berretta M, D'Amico G, Montalti R, De Ruvo N, Cautero N, Guerrini GP, Ballarin R, Spaggiari M, Tarantino G, Di Sandro S, Pecchi A, Luppi G, Gerunda GE. Liver resection for colorectal metastases in older adults: a paired matched analysis. J Am Geriatr Soc 2012; 59:2282-90. [PMID: 22188075 DOI: 10.1111/j.1532-5415.2011.03734.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess the safety and long-term results of hepatic resection of colorectal liver metastases (CLM) in older adults. DESIGN Case-control. SETTING Single liver and multivisceral transplant center. PARTICIPANTS Individuals with CLM: 32 aged 70 and older (older group) and 32 younger than 70 (younger group) matched in a 1:1 ratio according to sex, primary tumor site, liver metastases at diagnosis, number of metastases, maximum tumor size, infiltration of cut margin, type of hepatic resection, and hepatic resection timing. MEASUREMENTS Postoperative complications and survival rates. RESULTS There was no significant difference in preoperative clinical findings between the two study groups. The incidence of cumulative postoperative complications was similar in the older (28.1%) and younger (34.4%) groups (P = .10). One-, 3-, and 5-year disease-free survival rates were 57.6%, 32.9%, and 16.4%, respectively, in the younger group and 67.9%, 29.2%, and 19.5%, respectively, in the older group (P = .72). One-, 3-, and 5-year participant survival rates were 84.1%, 51.9%, and 33.3%, respectively, in the older group and 93.6%, 63%, and 28%, respectively, in the younger group (P = .50). CONCLUSIONS Resection of colorectal liver metastases in older adults can be performed with low mortality and morbidity and offers a long-time survival advantage to many of these individuals. Based on the results of this case-control study, older adults should be considered for surgical treatment whenever possible.
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Affiliation(s)
- Fabrizio Di Benedetto
- Liver and Multivisceral Transplant Center, Hepatopancreatic and Biliary Surgery, University of Modena and Reggio Emilia, Modena, Italy.
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Berretta M, Zanet E, Nasti G, Lleshi A, Frustaci S, Fiorica F, Bearz A, Talamini R, Lestuzzi C, Lazzarini R, Fisichella R, Cannizzaro R, Iaffaioli RV, Berretta S, Tirelli U. Oxaliplatin-based chemotherapy in the treatment of elderly patients with metastatic colorectal cancer (CRC). Arch Gerontol Geriatr 2011; 55:271-5. [PMID: 21937127 DOI: 10.1016/j.archger.2011.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 12/23/2022]
Abstract
Elderly patients constitute a subpopulation with special clinical features that differ from those of the general population and are under-represented in clinical trials. We retrospectively analyzed the toxicity and efficacy of oxaliplatin-based chemotherapy in the treatment of elderly patients affected by metastatic (m) CRC. Seventy-five consecutive patients aged 65-75 years (median age 71 years), 51 males and 24 females, with mCRC and measurable disease, were analyzed. The primary site of metastases was the liver (38.6% of patients). The majority of patients had a performance status (PS) according to the Eastern Cooperative Oncology Group (ECOG) PS before treatment of 0-1 (96%). The overall response rate was 57.3%, median progression-free survival was 7 months and median overall survival was 27 months. The main hematological and extra-hematological toxicities (grade 3 or 4) were neutropenia (20.0%), and neurological toxicity or diarrhea (6.7%), respectively. No toxic death occurred. Oxaliplatin-based chemotherapy maintains its efficacy, and safety in elderly patients with mCRC and good PS. This regimen should be considered in the treatment of this particular setting of patients.
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Affiliation(s)
- Massimiliano Berretta
- Department of Medical Oncology, National Cancer Institute, IRCCS, Via Franco Gallini 2, I-33081 Aviano (PN), Italy.
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Hubbard JM, Grothey A, Sargent DJ. Systemic therapy for elderly patients with gastrointestinal cancer. Clin Med Insights Oncol 2011; 5:89-99. [PMID: 21603244 PMCID: PMC3095025 DOI: 10.4137/cmo.s6983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The majority of patients with gastrointestinal cancers are over the age of 65. This age group comprises the minority of the patients enrolled in clinical trials, and it is unknown whether older patients achieve similar results as younger patients in terms of survival benefit and tolerability. In addition, there are few studies specifically designed for patients over 65 years. Subset analyses of individual trials and studies using pooled patient data from multiple trials provide some understanding on outcomes in older patients with gastrointestinal cancers. This article reviews the evidence on chemotherapeutic regimens in the elderly with colorectal, pancreatic, and gastroesophageal cancers, and discusses a practical approach to provide the best outcomes for older patients.
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Affiliation(s)
| | - Axel Grothey
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Daniel J. Sargent
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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