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Alabraba E, Gomez D. Systematic Review of Treatments for Colorectal Metastases in Elderly Patients to Guide Surveillance Cessation Following Hepatic Resection for Colorectal Liver Metastases. Am J Clin Oncol 2021; 44:210-223. [PMID: 33710135 DOI: 10.1097/coc.0000000000000803] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although included in surveillance programmes for colorectal cancer (CRC) metastases, elderly patients are susceptible to declines in health and quality of life that may render them unsuitable for further surveillance. Deciding when to cease surveillance is challenging. METHODS There are no publications focused on surveillance of elderly patients for CRC metastases. A systematic review of studies reporting treatment outcomes for CRC metastases in elderly patients was performed to assess the risk-benefit balance of the key objectives of surveillance; detecting and treating CRC metastases. RESULTS Sixty-eight eligible studies reported outcomes for surgery and chemotherapy in the elderly. Liver resections and use of chemotherapy, including biologics, are more conservative and have poorer outcomes in the elderly compared with younger patients. Selected studies demonstrated poorer quality-of-life (QoL) following surgery and chemotherapy. Studies of ablation in elderly patients are limited. DISCUSSION The survival benefit of treating CRC metastases with surgery or chemotherapy decreases with advancing age and QoL may decline in the elderly. The relatively lower efficacy and detrimental QoL impact of multimodal therapy options for detected CRC metastases in the elderly questions the benefit of surveillance in some elderly patients. Care of elderly patients should thus be customized based on their preference, formal geriatric assessment, natural life-expectancy, and the perceived risk-benefit balance of treating recurrent CRC metastases. Clinicians may consider surveillance cessation in patients aged 75 years and above if geriatric assessment is unsatisfactory, patients decline surveillance, or patient fitness deteriorates catastrophically.
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Affiliation(s)
- Edward Alabraba
- Department of Hepatobiliary Surgery and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust
| | - Dhanny Gomez
- Department of Hepatobiliary Surgery and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust
- NIHR Nottingham Digestive Disease Biomedical Research Unit, University of Nottingham, Nottingham, UK
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Chow Z, Gan T, Chen Q, Huang B, Schoenberg N, Dignan M, Evers BM, Bhakta AS. Nonadherence to Standard of Care for Locally Advanced Colon Cancer as a Contributory Factor for High Mortality Rates in Kentucky. J Am Coll Surg 2020; 230:428-439. [PMID: 32062006 DOI: 10.1016/j.jamcollsurg.2019.12.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Kentucky has one of the highest mortality rates for colon cancer, despite dramatic improvements in screening. The National Comprehensive Cancer Network (NCCN) guidelines recommend operation and adjuvant chemotherapy for locally advanced (stage IIb/c and stage III) colon cancer (LACC). The purpose of this study was to determine the rate of nonadherence with current standard of care (SOC) and associated factors as possible contributors to mortality. METHODS The Kentucky Cancer Registry database linked with administrative health claims was queried for individuals (20 years and older) diagnosed with LACC from 2007 to 2012. Bivariate and logistic regression of nonadherence was performed. Survival analysis was performed with Cox regression and Kaplan-Meier plots. RESULTS A total of 1,404 patients with LACC were included. Approximately 42% of patients with LACC were noted to be nonadherent to SOC, with nearly all (95.7%) failing to receive adjuvant chemotherapy. After adjusting for all significant factors, we found the factors associated with nonadherence included the following: age older than 75 years, stage III colon cancer, high Charlson Comorbidity Index (3+), low poverty level, Medicaid coverage, and disability. Adherence to SOC is associated with a significant improvement in the 5-year survival rate compared with nonadherence (63.0% and 27.4%, respectively; p < 0.0001). CONCLUSIONS Our study identified multiple factors associated with the failure of patients with LACC to receive SOC, particularly adjuvant chemotherapy, suggesting the need to focus on improving adjuvant chemotherapy compliance in specific populations. Nonadherence to LACC SOC is likely a major contributor to the persistently high mortality rates in Kentucky.
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Affiliation(s)
- Zeta Chow
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - Tong Gan
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - Quan Chen
- Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - Bin Huang
- Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - Mark Dignan
- Department of Internal Medicine, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - B Mark Evers
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - Avinash S Bhakta
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY.
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Revathi S, Hakkim FL, Ramesh Kumar N, Bakshi HA, Sangilimuthu AY, Tambuwala MM, Changez M, Nasef MM, Krishnan M, Kayalvizhi N. In Vivo Anti Cancer Potential of Pyrogallol in Murine Model of Colon Cancer. Asian Pac J Cancer Prev 2019; 20:2645-2651. [PMID: 31554359 PMCID: PMC6976835 DOI: 10.31557/apjcp.2019.20.9.2645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 08/18/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Colon cancer is aggressive and it causes 0.5 million deaths per year. Practicing natural medicines for cancer treatment is safer than conventional drugs. World health organization emphasizes on the importance of practicing natural medicines and developing natural product based drugs for cancer treatment. Recently we reported an anti colon cancer activity associated with pyrogallol isolated from medicinal plant Acacia nilotica in HT-29 cells in vitro. To extend our observation in this study we evaluated in vivo colon tumor remission property of acetone extract of A. nilotica (ACE) and pyrogallol. Materials and Methods: In vivo toxicity of ACE and pyrogallol was assessed and In vivo tumor remission activity of ACE and pyrogallol was determined in murine model. Results: Mice were tolerated different doses of ACE and pyrogallol. Tumor size was considerably reduced in pyrogallol treated mice similar to doxorubicin. Tumor bearing mice treated with ACE and pyrogallol showed mild decline in body weight. Conclusion: Pyrogallol was found to be an effective anti colon cancer agent with less toxicity.
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Affiliation(s)
- Seemaisamy Revathi
- Department of Zoology, Periyar University, Salem 636 011, Tamil Nadu, India. ,
| | - Faruck Lukmanul Hakkim
- Department of Mathematics and Sciences, College of Arts and Applied Sciences, , Dhofar University, Salalah, Oman
- Research Center, Dhofar University, Salalah, Oman
| | - Neelamegam Ramesh Kumar
- Insect Molecular Biology Laboratory, Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - Hamid A Bakshi
- School of Pharmacy and Pharmaceutical Sciences, Saad Centre for Pharmacy and Diabetes, Ulster University, Cromore Road, Coleraine, Co. Londonderry, BT52 1SA, United Kingdom
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, United Kingdom
| | | | - Murtaza M Tambuwala
- School of Pharmacy and Pharmaceutical Sciences, Saad Centre for Pharmacy and Diabetes, Ulster University, Cromore Road, Coleraine, Co. Londonderry, BT52 1SA, United Kingdom
| | - Mohammad Changez
- Chemistry Division, Department of Basic Sciences, College of Applied and Health Sciences, Sharqiyah University, Ibra, Oman
| | - Mohamed M Nasef
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, United Kingdom
| | - Muthukalingan Krishnan
- Insect Molecular Biology Laboratory, Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
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Rosati G, Cordio S, Reggiardo G, Aprile G, Butera A, Avallone A, Tucci A, Novello G, Blanco G, Caputo G, Bilancia D, Bordonaro R. Oxaliplatin-Based Chemotherapy in Patients with Metastatic Colorectal Cancer Aged at Least 75 Years: A Post-Hoc Subgroup Analysis of Three Phase II Trials. Cancers (Basel) 2019; 11:cancers11040578. [PMID: 31022922 PMCID: PMC6521155 DOI: 10.3390/cancers11040578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 12/21/2022] Open
Abstract
Patients older than 75 years of age are usually excluded from metastatic colorectal cancer studies based on a combination chemotherapy containing oxaliplatin. Our group conducted three phase II trials in elderly patients in recent years. A post-hoc subgroup analysis of 67 patients aged at least 75 years was included in this study. Oxaliplatin was combined with capecitabine in two trials and with uracil-tegafur (UFT) plus folinic acid in the third trial. In one study, bevacizumab was also added to chemotherapy. The median age of patients was 77 years, and all had a good performance status (0 to 1). The observed overall response rate was 45%, comparable to younger patients (51%, p = 0.49). The estimated median progression-free survival (PFS) time and overall survival (OS) time were 8.7 and 19.3 months, respectively. These results did not significantly differ from those in younger patients (8.0 months for PFS (p = 0.58) and 19.7 months for OS (p = 0.94), respectively). The most common grade 3–4 adverse events included diarrhea (13%), fatigue (13%), peripheral neuropathy (10%), and neutropenia (7%). Moreover, the toxicity was never statistically different from that in younger patients. The efficacy of oxaliplatin-based combination was maintained in fit elderly patients ≥75 years.
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Affiliation(s)
- Gerardo Rosati
- U.O. Oncologia Medica, Azienda Ospedaliera S. Carlo, 85100 Potenza, Italy.
| | - Stefano Cordio
- Struttura Complessa di Oncologia Medica, Ospedale Garibaldi, 95122 Catania, Italy.
| | - Giorgio Reggiardo
- Biostatistics and Data Management Unit, Medi Service S.r.l., 16149 Genova, Italy.
| | - Giuseppe Aprile
- Dipartimento di Oncologia Clinica, Ospedale San Bortolo, AULSS8, 36100 Vicenza, Italy.
| | - Alfredo Butera
- U.O. Oncologia Medica, Ospedale S. Giovanni di Dio, 92100 Agrigento, Italy.
| | - Antonio Avallone
- Struttura Complessa di Oncologia Clinica Sperimentale Addome, Dipartimento Assistenziale e di Ricerca dei Percorsi Oncologici del Distretto Addominale, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, 80131 Napoli, Italy.
| | - Aniello Tucci
- U.O. Oncologia Medica, ASL NA3 Sud, 80035 Nola (NA), Italy.
| | - Giuseppe Novello
- U.O. Oncologia Medica, Azienda Ospedaliero-Universitaria "Vittorio Emanuele", 95124 Catania, Italy.
| | - Giuseppina Blanco
- U.O. Oncologia Medica, Istituto Oncologico del Mediterraneo, 95029 Viagrande (CT), Italy.
| | - Giuseppe Caputo
- U.O. Oncologia Medica, Azienda Ospedaliera Gravina, 95041 Caltagirone, Italy.
| | - Domenico Bilancia
- U.O. Oncologia Medica, Azienda Ospedaliera S. Carlo, 85100 Potenza, Italy.
| | - Roberto Bordonaro
- Struttura Complessa di Oncologia Medica, Ospedale Garibaldi, 95122 Catania, Italy.
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Fu J, Ruan H, Zheng H, Cai C, Zhou S, Wang Q, Chen W, Fu W, Du J. Impact of old age on resectable colorectal cancer outcomes. PeerJ 2019; 7:e6350. [PMID: 30792941 PMCID: PMC6378948 DOI: 10.7717/peerj.6350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/27/2018] [Indexed: 12/27/2022] Open
Abstract
Objective This study was performed to identify a reasonable cutoff age for defining older patients with colorectal cancer (CRC) and to examine whether old age was related with increased colorectal cancer-specific death (CSD) and poor colorectal cancer-specific survival (CSS). Methods A total of 76,858 eligible patients from the surveillance, epidemiology, and end results (SEER) database were included in this study. The Cox proportional hazard regression model and the Chow test were used to determine a suitable cutoff age for defining the older group. Furthermore, a propensity score matching analysis was performed to adjust for heterogeneity between groups. A competing risk regression model was used to explore the impact of age on CSD and non-colorectal cancer-specific death (non-CSD). Kaplan-Meier survival curves were plotted to compare CSS between groups. Also, a Cox regression model was used to validate the results. External validation was performed on data from 1998 to 2003 retrieved from the SEER database. Results Based on a cutoff age of 70 years, the examined cohort of patients was classified into a younger group (n = 51,915, <70 years of old) and an older group (n = 24,943, ≥70 years of old). Compared with younger patients, older patients were more likely to have fewer lymph nodes sampled and were less likely to receive chemotherapy and radiotherapy. When adjusted for other covariates, age-dependent differences of 5-year CSD and 5-year non-CSD were significant in the younger and older groups (15.84% and 22.42%, P < 0.001; 5.21% and 14.21%, P < 0.001). Also an age of ≥70 years remained associated with worse CSS comparing with younger group (subdistribution hazard ratio, 1.51 95% confidence interval (CI) [1.45-1.57], P < 0.001). The Cox regression model as a sensitivity analysis had a similar result. External validation also supported an age of 70 years as a suitable cutoff, and this older group was associated with having reduced CSS and increased CSD. Conclusions A total of 70 is a suitable cutoff age to define those considered as having elderly CRC. Elderly CRC was associated with not only increased non-CSD but also with increased CSD. Further research is needed to provide evidence of whether cases of elderly CRC should receive stronger treatment if possible.
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Affiliation(s)
- Jianfei Fu
- Department of Medical Oncology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, P.R. China
| | - Hang Ruan
- Department of Colorectal Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, P.R. China
| | - Hongjuan Zheng
- Department of Medical Oncology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, P.R. China
| | - Cheng Cai
- Department of Colorectal Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, P.R. China
| | - Shishi Zhou
- Department of Medical Oncology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, P.R. China
| | - Qinghua Wang
- Department of Medical Oncology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, P.R. China
| | - Wenbin Chen
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Wei Fu
- Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jinlin Du
- Department of Colorectal Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, P.R. China
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Watanabe A, Yang CC, Cheung WY. Association of baseline patient characteristics with adjuvant chemotherapy toxicities in stage III colorectal cancer patients. Med Oncol 2018; 35:125. [PMID: 30117039 DOI: 10.1007/s12032-018-1188-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/31/2018] [Indexed: 12/17/2022]
Abstract
Toxicities can affect cancer patients' quality of life resulting in poor adherence to adjuvant chemotherapy (AC). While previous studies have explored the prevalence of toxicities following AC, few have examined the associations of baseline characteristics, such as age, sex, and performance status, with toxicity outcomes. In this study, we reviewed a cohort of 371 colorectal cancer patients treated with adjuvant monotherapy (capecitabine ) or combination therapy (FOLFOX or CAPOX) within 12 weeks of curative resection, and determined the associations between baseline characteristics and toxicity outcomes. Median age was 65 years, 52% were men, and 41% received monotherapy. A number of toxicities appeared to decrease with successive AC cycles. For monotherapy, univariate analyses found that age, sex, performance status, and pre-treatment anemia were associated with hematological toxicities whereas tumor location was associated with gastrointestinal (GI) toxicities (all P < 0.05). On multivariate analyses, hematological toxicities were predicted by advanced age (≥ 70) (OR 3.30; 95% CI 1.17-9.37; P = 0.025) and pre-treatment anemia (OR 23.18; 95% CI 6.36-84.48; P < 0.001), while GI toxicities were less likely to occur among tumors at or distal to the splenic flexure (OR 0.38; 95% CI 0.15-0.99; P = 0.047). For combination therapy, sex and pre-treatment anemia were associated with hematological toxicities (all P < 0.05), but only female sex was predictive on multivariate analyses (OR 5.13; 95% CI 2.08-12.68; P < 0.001). In conclusion, few baseline characteristics were associated with treatment toxicities. These findings may better inform discussions with patients and caregivers during AC decision-making and underscore to clinicians the need for close monitoring of patients during treatment.
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Affiliation(s)
- Akie Watanabe
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chang Cheng Yang
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, AB, Canada. .,Section of Medical Oncology, Tom Baker Cancer Centre, 1331 29 ST NW, Calgary, AB, T2N 4N2, Canada.
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Antonio M, Carmona-Bayonas A, Saldaña J, Navarro V, Tebé C, Salazar R, Borràs JM. Factors Predicting Adherence to a Tailored-Dose Adjuvant Treatment on the Basis of Geriatric Assessment in Elderly People With Colorectal Cancer: A Prospective Study. Clin Colorectal Cancer 2017; 17:e59-e68. [PMID: 29054805 DOI: 10.1016/j.clcc.2017.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 09/20/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Selecting elderly people with colorectal cancer (CRC) for adjuvant chemotherapy is challenging. Comprehensive geriatric assessment (CGA) can help by classifying them according to their frailty profile. The supposed benefit of chemotherapy is on the basis of the rate of treatment adherence. In this study we evaluated tolerance and adherence to tailored-dose adjuvant therapy on the basis of CGA in a cohort of older patients with high-risk stage II and stage III CRC. PATIENTS AND METHODS This was a prospective study in 193 consecutive patients aged 75 years or older. On the basis of CGA results, we classified patients as fit, medium fit, or unfit, administering standard therapy, adjusted treatment, and best supportive care, respectively. We recorded planned chemotherapy, toxicity, and completion of the treatment. A logistic multivariate analysis was carried out. RESULTS Seventeen (15%) of the 141 candidates for chemotherapy (n = 86 fit and n = 55 medium fit) refused treatment; associated factors included polypharmacy (odds ratio [OR], 5.34; 95% confidence interval [CI], 1.55-18.40) and rectal location (OR, 5.61; 94% CI, 1.45-21.49). Of the 105 (74%) patients receiving chemotherapy, 20 (27%) fit and 4 (13%) medium fit patients experienced Grade 3 to 4 toxicity (P = .11) without association to explanatory variables. Approximately 55% of patients treated with chemotherapy received at least 80% of the planned dose (55% fit and 58% medium fit patients; P = .7). Factors associated with completion of chemotherapy were the absence of toxicity (OR, 7.67; 95% CI, 2.41-24.43) and social support (OR, 2.29; 95% CI, 0.08-1.04). CONCLUSION CGA is useful for selecting elderly patients for adjuvant chemotherapy, adapting the dose to their frailty profile, and identifying adherence-related factors amenable to modification through CGA-based interventions.
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Affiliation(s)
- Maite Antonio
- Medical Oncology Department, Institut d'Investigació Biomèdica de Bellvitge, Institut Català d'Oncologia-Hospital Duran i Reynals, University of Barcelona, Barcelona, Spain.
| | | | - Juana Saldaña
- Medical Oncology Department, Institut d'Investigació Biomèdica de Bellvitge, Institut Català d'Oncologia-Hospital Duran i Reynals, University of Barcelona, Barcelona, Spain
| | - Valentí Navarro
- Research Clinical Unit, Institut Català d'Oncologia-Hospital Duran I Reynals, Barcelona, Spain
| | - Cristian Tebé
- Statisical Assessment Service, Institut d'Investigació Biomèdica de Bellvitge and Universitat Rovira i Virgili, Barcelona, Spain
| | - Ramon Salazar
- Medical Oncology Department, Institut d'Investigació Biomèdica de Bellvitge, Institut Català d'Oncologia-Hospital Duran i Reynals, University of Barcelona, Barcelona, Spain
| | - Josep Maria Borràs
- Department of Clinical Sciences, University of Barcelona and Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
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Recurrence-free and overall survival among elderly stage III colon cancer patients treated with CAPOX or capecitabine monotherapy. Int J Cancer 2016; 140:224-233. [DOI: 10.1002/ijc.30423] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/25/2016] [Accepted: 08/12/2016] [Indexed: 12/13/2022]
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Bradley CJ, Yabroff KR, Warren JL, Zeruto C, Chawla N, Lamont EB. Trends in the Treatment of Metastatic Colon and Rectal Cancer in Elderly Patients. Med Care 2016; 54:490-7. [DOI: 10.1097/mlr.0000000000000510] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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10
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Razenberg LGEM, van Gestel YRBM, Lemmens VEPP, de Hingh IHJT, Creemers GJ. Bevacizumab in Addition to Palliative Chemotherapy for Patients With Peritoneal Carcinomatosis of Colorectal Origin: A Nationwide Population-Based Study. Clin Colorectal Cancer 2015; 15:e41-6. [PMID: 26762572 DOI: 10.1016/j.clcc.2015.12.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/27/2015] [Accepted: 12/09/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most patients with colorectal cancer (CRC) presenting with peritoneal carcinomatosis (PC) rely on palliative systemic treatment options. However, data on the use and effect of systemic treatment strategies, including targeted agents for the palliative treatment of colorectal PC, are lacking. We conducted a nationwide population-based study with data from the period in which the targeted agent bevacizumab was introduced in the Netherlands. PATIENTS AND METHODS The present study included all patients diagnosed from 2007 to 2014 with synchronous PC from CRC treated with only palliative systemic therapy. We assessed the use of bevacizumab, the standard choice of targeted treatment, in addition to first-line chemotherapy. Multivariable logistic regression analyses were performed to calculate the predictors for the additional prescription of bevacizumab. Survival estimates were calculated, and multivariable Cox analyses were performed to estimate the hazard ratios (HRs) of death stratified by the treatment received. RESULTS A total of 1235 patients received palliative chemotherapy, of whom 436 also received bevacizumab (35%). Patients aged ≥ 75 years and patients with PC from colonic tumors were less likely to receive chemotherapy plus bevacizumab. The addition of bevacizumab to palliative chemotherapy was associated with an improved overall median survival of 7.5 versus 11 months in both patients with isolated PC and those with concomitant extraperitoneal metastases. The improvement remained after adjustment for patient and tumor characteristics (HR, 0.7; 95% confidence interval, 0.64-0.83). CONCLUSION The results of the present nationwide population-based study support the rationale for bevacizumab in addition to palliative chemotherapy for patients with PC of CRC and underline the need for ongoing efforts to precisely determine the role of targeted therapy in the treatment of PC.
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Affiliation(s)
- Lieke G E M Razenberg
- Department of Oncology, Catharina Hospital, Eindhoven, Netherlands; Department of Registry and Research, Netherlands Comprehensive Cancer Organization, Eindhoven, Netherlands.
| | - Yvette R B M van Gestel
- Department of Registry and Research, Netherlands Comprehensive Cancer Organization, Eindhoven, Netherlands
| | - Valery E P P Lemmens
- Department of Registry and Research, Netherlands Comprehensive Cancer Organization, Eindhoven, Netherlands; Department of Public Health, Erasmus Medical Center University Medical Centre, Rotterdam, Netherlands
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Lu CS, Chang PY, Chen YG, Chen JH, Wu YY, Ho CL. Stage III Colon Cancer: The Individualized Strategy of Adjuvant Chemotherapy for Aged Under and Over 70. PLoS One 2015; 10:e0138632. [PMID: 26382962 PMCID: PMC4575165 DOI: 10.1371/journal.pone.0138632] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023] Open
Abstract
Background The aim of this study was to examine the specific chemoregimens selected for adjuvant therapy in the patients with stage III colon cancer. We investigated the trends in chemotherapeutic prescribing patterns and looked for adequate therapeutic setting for these patients. Methods 288 patients presenting with stage III colon cancer and undergoing adjuvant therapies after curative surgery for more than 3-month were enrolled between January 2006 and December 2011. Demographic characteristics and therapeutic factors were analyzed, including age, gender, histological grade, tumor sizes, tumor location, pathologic stage, performance status, serum carcinoembryonic antigen, regimens selection, interval from the operation to the start of adjuvant therapy and prolonged adjuvant therapy. Kaplan– Meier methods were utilized for drawing survival curves and Cox model was used to analyze survival, prognostic factors. Results The analysis showed that the patients aged under 70 received more intensive therapies than those aged over 70 (P<0.001). Later, advanced analysis in therapeutic factors was conducted between the patients aged under 70 and those over 70. In the patients aged under 70, significant differences in 4-year overall survival (OS) were noted between UFUR (oral tegafur-uracil plus leucovorin) groups and FOLFOX (5-FU plus oxaliplatin) [65.6% versus (vs) 89.8%, relative risk (RR) 3.780, 95% confidence interval (CI) 1.263–11.315, P = 0.017]. There were also differences in 4-year OS between these patients with and without oxaliplatin-contained regimens (92.1% vs 83.4%, respectively, RR 0.385, 95% CI 0.157–0.946, P = 0.037). In addition, the patients who received intravenous or combined therapy also had higher 4-year OS than those only received oral regimens (92.1% vs 76.6%, P = 0.077), though the finding did not reach statistical significance. In contrast to the survival benefits of above therapeutic settings for the patients aged under 70, there was less advantage in the old patients when they received intensive therapies or even oxaliplatin-contained regimens. Prolonged cycles of adjuvant therapy resulted in no significant benefit to survival rates regardless of ages. Conclusions The adequate individualized therapeutic strategy plays an important role for stage III colon cancer. Our findings suggested that benefit of oxaliplatin-contained therapy is limited to patients aged under 70 and oral fluoropyrimidines may be an effective option for old patients. In addition, prolonged adjuvant setting is suggested to be unbeneficial for managing stage III colon cancer.
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Affiliation(s)
- Chieh-Sheng Lu
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (CSL); (CLH)
| | - Ping-Ying Chang
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Guang Chen
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jia-Hong Chen
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Ying Wu
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Liang Ho
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (CSL); (CLH)
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12
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Murphy CC, Harlan LC, Lund JL, Lynch CF, Geiger AM. Patterns of Colorectal Cancer Care in the United States: 1990-2010. J Natl Cancer Inst 2015. [PMID: 26206950 DOI: 10.1093/jnci/djv198] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) mortality has declined in the United States, in part because of advances in treatment. Few studies have evaluated the adoption of therapies and temporal changes in patterns of care. METHODS Patients age 20 years and older diagnosed with stages II/III CRC were randomly sampled from the population-based Surveillance, Epidemiology, and End Results (SEER) program in 1990-1991, 1995, 2000, 2005, and 2010 (n = 7057). Therapy was obtained from medical records and physician verification. We described the receipt of chemotherapy and radiation therapy. Log-binomial regression was used to examine factors associated with therapy. All statistical tests were two-sided. RESULTS Chemotherapy receipt among colon cancer patients increased from 1990 (stage II: 22.5%; stage III: 56.3%) to 2005 (stage II: 32.1%; stage III: 72.4%) and declined slightly in 2010 (stage II: 29.3%; stage III: 66.4%). Stage III colon cancer patients who were older (vs <55 years, 75-79 years: risk ratio [RR] 0.81, 95% confidence interval [CI] = 0.71 to 0.91; ≥80 years: RR = 0.37, 95% CI = 0.28 to 0.47) or had a comorbidity score of 2 or higher (vs 0, RR = 0.56, 95% CI = 0.35 to 0.87) received chemotherapy less often. Receipt of radiation therapy by rectal cancer patients increased across all years from 45.5% to 66.1%. Increasing age (vs <55 years, 75-79 years: RR = 0.59, 95% CI = 0.47 to 0.74; ≥80 years: RR = 0.33, 95% CI = 0.25 to 0.45) was associated with lower chemoradiation use among stage II/III rectal cancer patients. CONCLUSION Our findings demonstrate increased adoption of chemotherapy and radiation therapy for colon and rectal cancer patients and differences in therapy by age, comorbidity, and diagnosis year. Increased receipt of these therapies in the community may further reduce CRC mortality.
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Affiliation(s)
- Caitlin C Murphy
- Affiliations: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (CCM, JLL); Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (LCH, AMG); Department of Epidemiology, University of Iowa, Iowa City, IA (CFL).
| | - Linda C Harlan
- Affiliations: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (CCM, JLL); Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (LCH, AMG); Department of Epidemiology, University of Iowa, Iowa City, IA (CFL)
| | - Jennifer L Lund
- Affiliations: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (CCM, JLL); Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (LCH, AMG); Department of Epidemiology, University of Iowa, Iowa City, IA (CFL)
| | - Charles F Lynch
- Affiliations: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (CCM, JLL); Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (LCH, AMG); Department of Epidemiology, University of Iowa, Iowa City, IA (CFL)
| | - Ann M Geiger
- Affiliations: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (CCM, JLL); Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (LCH, AMG); Department of Epidemiology, University of Iowa, Iowa City, IA (CFL)
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13
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Turner NH, Wong HL, Field K, Wong R, Shapiro J, Yip D, Nott L, Tie J, Kosmider S, Tran B, Desai J, McKendrick J, Zimet A, Richardson G, Iddawela M, Gibbs P. Novel quality indicators for metastatic colorectal cancer management identify significant variations in these measures across treatment centers in Australia. Asia Pac J Clin Oncol 2015; 11:262-71. [DOI: 10.1111/ajco.12355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Natalie Heather Turner
- The Walter and Eliza Hall Institute of Medical Research; Melbourne Victoria Australia
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Hui-li Wong
- The Walter and Eliza Hall Institute of Medical Research; Melbourne Victoria Australia
| | - Kathryn Field
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Rachel Wong
- Department of Medical Oncology; Eastern Health; Melbourne Victoria Australia
- Eastern Health Medical School; Monash University; Melbourne Victoria Australia
| | | | - Desmond Yip
- The Canberra Hospital; Canberra Australian Capital Territory Australia
- Calvary Hospital; Canberra Australian Capital Territory Australia
- ANU Medical School; Australian National University; Canberra Australian Capital Territory Australia
| | - Louise Nott
- Royal Hobart Hospital; Hobart Tasmania Australia
| | - Jeanne Tie
- The Walter and Eliza Hall Institute of Medical Research; Melbourne Victoria Australia
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medical Oncology; Western Hospital; Melbourne Victoria Australia
| | - Suzanne Kosmider
- Department of Medical Oncology; Western Hospital; Melbourne Victoria Australia
| | - Ben Tran
- The Walter and Eliza Hall Institute of Medical Research; Melbourne Victoria Australia
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medical Oncology; Western Hospital; Melbourne Victoria Australia
| | - Jayesh Desai
- The Walter and Eliza Hall Institute of Medical Research; Melbourne Victoria Australia
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Joseph McKendrick
- Department of Medical Oncology; Eastern Health; Melbourne Victoria Australia
| | - Allan Zimet
- Epworth Hospital; Melbourne Victoria Australia
| | | | - Mahesh Iddawela
- Goulburn Valley Health; Shepparton Victoria Australia
- University of Melbourne Rural Health Academic Centre; Shepparton Victoria Australia
| | - Peter Gibbs
- The Walter and Eliza Hall Institute of Medical Research; Melbourne Victoria Australia
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
- Royal Hobart Hospital; Hobart Tasmania Australia
- BioGrid Australia; Melbourne Victoria Australia
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14
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Rosati G, Aprile G, Poletto E, Avallone A. An update on the management of metastatic colorectal cancer in the elderly. COLORECTAL CANCER 2014. [DOI: 10.2217/crc.14.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
SUMMARY The availability of new chemotherapeutic and targeted agents has changed the life expectancy of patients with metastatic colorectal cancer thanks to the possibility of sequentially administering fluoropyrimidines combined with irinotecan and oxaliplatin plus monoclonal antibodies. This approach is seldom feasible in the elderly, especially because of the poor tolerability of some agents. Frail patients should only receive palliative treatment. Oppositely, fit elderly patients can be treated with more aggressive therapies, similarly to the younger ones. What is not sufficiently known is how to manage the elderly categorized as intermediate. In the coming years, it appears necessary how to accurately differentiate the elderly through a comprehensive geriatric assessment performed with validated scales and uniformed criteria simpler than those currently available.
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Affiliation(s)
- Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - Giuseppe Aprile
- Department of Medical Oncology, University Hospital, Udine, Italy
| | - Elena Poletto
- Department of Medical Oncology, University Hospital, Udine, Italy
| | - Antonio Avallone
- Department of Gastrointestinal Medical Oncology, National Cancer Institute, Naples, Italy
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15
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A Chinese herbal Formula, Chang-Wei-Qin, Synergistically Enhances Antitumor Effect of Oxaliplatin. Pathol Oncol Res 2014; 21:389-97. [DOI: 10.1007/s12253-014-9831-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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16
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Han JP, Hong SJ, Kim SH, Choi JH, Jung HJ, Cho YH, Ko BM, Lee MS. Palliative self-expandable metal stents for acute malignant colorectal obstruction: clinical outcomes and risk factors for complications. Scand J Gastroenterol 2014; 49:967-73. [PMID: 24874189 DOI: 10.3109/00365521.2014.920914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Self-expandable metal stents (SEMSs) have been used as palliative treatment or bridge to surgery for obstructions caused by colorectal cancer (CRC). We assessed the long-term outcomes of palliative SEMSs and evaluated the risk factors influencing complications. MATERIALS AND METHODS One hundred and seventy-five patients underwent SEMS placement for acute malignant colorectal obstruction. Of the 72 patients who underwent palliative treatment for primary CRC, 30 patients received chemotherapy (CT) for primary cancer (CT group) and 42 underwent best supportive treatment (BST) without CT (BST group). RESULTS There was a significant difference in late migration between the CT group and the BST group (20.0% in CT group, 2.4% in BST group, p = 0.018). Response to CT influenced the rate of late obstruction (0% in disease control, 35.7% in disease progression, p = 0.014). However, late obstruction was not associated with stent properties, such as diameter or type (≤22 mm vs. >22 mm, 13.5% vs. 14.3%, p = 1.00; uncovered stent vs. covered stent, 15.5% vs. 7.1%, p = 0.675) and migration (≤22 mm vs. >22 mm, 16.2% vs. 2.9%, p = 0.108; uncovered stent vs. covered stent, 8.6% vs. 14.3%, p = 0.615) in palliative SEMS. CONCLUSION The administration of CT increases the rate of stent migration, and disease control by CT can reduce the risk of obstruction by maintaining the luminal patency of palliative SEMSs.
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Affiliation(s)
- Jae Pil Han
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine , Bucheon , Korea
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17
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Papamichael D, Audisio RA, Glimelius B, de Gramont A, Glynne-Jones R, Haller D, Köhne CH, Rostoft S, Lemmens V, Mitry E, Rutten H, Sargent D, Sastre J, Seymour M, Starling N, Van Cutsem E, Aapro M. Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol 2014; 26:463-76. [PMID: 25015334 DOI: 10.1093/annonc/mdu253] [Citation(s) in RCA: 275] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in Europe and worldwide, with the peak incidence in patients >70 years of age. However, as the treatment algorithms for the treatment of patients with CRC become ever more complex, it is clear that a significant percentage of older CRC patients (>70 years) are being less than optimally treated. This document provides a summary of an International Society of Geriatric Oncology (SIOG) task force meeting convened in Paris in 2013 to update the existing expert recommendations for the treatment of older (geriatric) CRC patients published in 2009 and includes overviews of the recent data on epidemiology, geriatric assessment as it relates to surgery and oncology, and the ability of older CRC patients to tolerate surgery, adjuvant chemotherapy, treatment of their metastatic disease including palliative chemotherapy with and without the use of the biologics, and finally the use of adjuvant and palliative radiotherapy in the treatment of older rectal cancer patients. An overview of each area was presented by one of the task force experts and comments invited from other task force members.
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Affiliation(s)
- D Papamichael
- Department of Medical Oncology, B.O. Cyprus Oncology Centre, Nicosia, Cyprus
| | | | - B Glimelius
- Department of Radiology, Oncology and Radiation Science, University of Uppsala, Uppsala, Sweden
| | | | | | - D Haller
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, USA
| | - C-H Köhne
- Klinikum Oldenburg, Oldenburg, Germany
| | - S Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - V Lemmens
- Erasmus MC University Medical Centre, Rotterdam Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), Eindhoven, The Netherlands
| | - E Mitry
- Department of Medical Oncology, Institut Curie, Paris Université Versailles Saint-Quentin, Guyancourt, France
| | - H Rutten
- Catharina Hospital Eindhoven, Eindhoven Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - J Sastre
- Department of Medical Oncology, Hospital Clinico San Carlos, Madrid, Spain
| | - M Seymour
- Cancer Medicine and Pathology, University of Leeds, Leeds
| | - N Starling
- Gastrointestinal Unit, Royal Marsden Hospital, London, UK
| | - E Van Cutsem
- Digestive Oncology, Leuven Cancer Institute, Leuven, Belgium
| | - M Aapro
- SIOG Office, Clinique de Genolier, Genolier, Switzerland
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18
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Reese ES, Onukwugha E, Hanna N, Seal BS, Mullins CD. Clinical and demographic characteristics associated with the receipt of chemotherapy treatment among 7951 elderly metastatic colon cancer patients. Cancer Med 2013; 2:907-15. [PMID: 24403264 PMCID: PMC3892395 DOI: 10.1002/cam4.143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/31/2013] [Accepted: 09/02/2013] [Indexed: 12/25/2022] Open
Abstract
Among older individuals diagnosed with metastatic colon cancer (mCC) there is limited evidence available that describes the characteristics associated with advancing to second- and subsequent lines of treatment with chemotherapy/biologics. Our objective was to describe the trends and lines of treatment received among elderly mCC patients. Elderly beneficiaries diagnosed with mCC from 2003 to 2007 were identified in the Surveillance, Epidemiology and End Results (SEER)-Medicare dataset. Beneficiaries were followed up until death or censoring. Treatment lines were classified in combinations of chemotherapies and biologics. Modified Poisson regression was used to predict receipt of lines of treatment. Analyses controlled for age, race/ethnicity, gender, marital status, state buy-in during diagnosis year, SEER-registry site, Charlson comorbidity index (CCI), poor performance indicators, surgery of primary site, and surgery of regional/distal sites. Among 7951 Medicare beneficiaries identified with mCC, 3266 initiated therapy. Of these, 1440 advanced to second-line treatment. Of these, 274 advanced to a subsequent-line treatment. Surgeries of the primary tumor site and of the regional/distal sites and marital status were the most significant variables associated with advancing through second- and subsequent-line treatments. Greater than 80 years of age, African American race, SEER-registry area, less than 6 months state buy-in assistance in mCC diagnosis year, and having poor performance indicators were inversely associated with receipt of second- or subsequent-line treatments. Among elderly individuals diagnosed with mCC, we identified demographic, clinical, and regional factors associated with receipt of second- and subsequent-line chemotherapy/biologics. Additional research is warranted to understand the role of physician versus patient preferences as well as geographic differences explaining why patients advance through lines of chemotherapy.
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Affiliation(s)
- Emily S Reese
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore, Maryland
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Glucagon-like peptide 2 in colon carcinogenesis: Possible target for anti-cancer therapy? Pharmacol Ther 2013; 139:87-94. [DOI: 10.1016/j.pharmthera.2013.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 03/21/2013] [Indexed: 12/18/2022]
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20
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McCleary NJ, Odejide O, Szymonifka J, Ryan D, Hezel A, Meyerhardt JA. Safety and effectiveness of oxaliplatin-based chemotherapy regimens in adults 75 years and older with colorectal cancer. Clin Colorectal Cancer 2013; 12:62-9. [PMID: 23102897 PMCID: PMC3802549 DOI: 10.1016/j.clcc.2012.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 09/10/2012] [Accepted: 09/13/2012] [Indexed: 12/27/2022]
Abstract
UNLABELLED Although the safety and efficacy of oxaliplatin-based chemotherapy regimens for colorectal cancer (CRC) have been demonstrated in adults > 75 years of age enrolled in clinical trials, safety and effectiveness outside the trial setting are less established. In this comparative effectiveness study, we note that older adults with stage III and metastatic CRC treated outside of a clinical trial experienced safety and effectiveness of oxaliplatin-based chemotherapy regimens comparable to that of younger adults. BACKGROUND Although the safety and efficacy of oxaliplatin-based chemotherapy regimens for colorectal cancer (CRC) have been demonstrated in adults ≥ 75 years of age who are enrolled in clinical trials, safety and effectiveness outside the trial setting are less established. METHODS We retrospectively collected cases of patients ≥ 75 years of age who were diagnosed with stage III and metastatic CRC and initiated treatment between January 2000 and January 2007 at 2 academic hospitals in Boston, MA. Cases were matched in a 1:2 ratio to controls who were < 75 years of age by hospital site, stage of disease (stage III vs. metastatic) and line of therapy (first- or second-line or beyond). The primary study endpoints were grade ≥ 3 treatment-associated toxicities and intolerance (number of dose delays/reductions and hospital/facility admissions during treatment). The secondary endpoint was overall survival. RESULTS We identified 84 patients ≥ 75 years of age (25% ≥ 80 years) and 168 controls. In the cohort, 77% had colon cancer, 75% had metastatic disease, and 60% were receiving oxaliplatin as first-line therapy. There was no significant difference in grade ≥ 3 treatment-associated toxicities between the patients and the controls (71.4% vs. 68.5%, respectively; P = .63). Further there was no statistically significant difference between patients and controls for combined endpoints of any grade ≥ 3 toxicity or hospital/facility admission (P = .92). With a median follow-up of 52 months, 2-year overall survival was similar between patients and controls (43% vs. 52%, respectively; P = .87). CONCLUSION Older adults with stage III and metastatic CRC treated outside of a clinical trial experienced safety and effectiveness of oxaliplatin-based chemotherapy regimens that was comparable to that of younger adults.
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