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Yamada Y, Yoshimatsu K, Yokomizo H, Okayama S, Satake M, Ida A, Maeda H, Shiozawa S. Capecitabine Plus Bevacizumab as First-Line Therapy for Patients with Metastatic Colorectal Cancer and Poor Performance Status. J NIPPON MED SCH 2021; 88:496-499. [PMID: 32999176 DOI: 10.1272/jnms.jnms.2021_88-415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The benefit of chemotherapy for patients with metastatic colorectal cancer has not been established. METHODS We retrospectively evaluated the effectiveness of chemotherapy with capecitabine and bevacizumab for patients with a performance status (PS) of 3. RESULTS Seven patients were included; median age was 82 years (range, 65-91 years). Response was not ascertained; however, the disease control rate was 83.3%. Median PFS and OS were 10.0 and 25.8 months, respectively. Hand-foot syndrome was the most common toxicity observed (3 patients; 42.9%). Grade 3 toxicity was observed in 1 patient with proteinuria and 1 with hypertension. CONCLUSION Chemotherapy using capecitabine and bevacizumab appeared to improve OFS and OS for patients with poor PS. However, care must be taken not to impose unnecessary burdens on patients with poor PS.
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Affiliation(s)
- Yasufumi Yamada
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Kazuhiko Yoshimatsu
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Hajime Yokomizo
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Sachiyo Okayama
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Masaya Satake
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Arika Ida
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Hiroyuki Maeda
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Shunichi Shiozawa
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
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Monteiro AR, Conde RS, Basto R, Sclafani F, Deleporte A, Hendlisz A, Dal Lago L. Targeted agents in older patients with gastrointestinal cancers - An overview. J Geriatr Oncol 2021; 12:1240-1252. [PMID: 34226158 DOI: 10.1016/j.jgo.2021.06.013] [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: 04/07/2021] [Revised: 06/12/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022]
Abstract
Targeted agents have been increasingly used in different malignancies and are associated with improved survival outcomes, including gastrointestinal cancers. Their use in the treatment of older patients is appealing given their favorable toxicity profile. In the last years, this subgroup of patients has been attracting increased interest given their representativeness and specific clinical needs. Nonetheless, the lack of data on efficacy and safety of standard treatments in older patients hinders proper evidence-based decision-making, leaving most therapeutic recommendations to be extrapolated from registration trials with low representation of older and frail patients. However, even if most decisions regarding the use of targeted agents in older patients with gastrointestinal cancer remain guided by subanalyses of large trials, data from recent older adult-specific trials are beginning to emerge, particularly in colorectal cancer. This review aims to summarize the existing evidence on treatment of older patients with gastrointestinal carcinomas (colon and rectum, stomach, esophagus, liver, and pancreas) with targeted agents (cetuximab, panitumumab, bevacizumab, ramucirumab, aflibercept, regorafenib, encorafenib, trastuzumab, sorafenib, lenvatinib, cabozantinib, erlotinib, olaparib), and place the evidence in a geriatric oncology perspective.
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Affiliation(s)
- Ana Raquel Monteiro
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Department of Medical Oncology, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal.
| | - Rita Saúde Conde
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Department of Medical Oncology, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal.
| | - Raquel Basto
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Department of Medical Oncology, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal.
| | - Francesco Sclafani
- Institut Jules Bordet, Department of Medicine, Blvd de Waterloo 121, 1000 Brussels, Belgium.
| | - Amélie Deleporte
- Institut Jules Bordet, Department of Medicine, Blvd de Waterloo 121, 1000 Brussels, Belgium.
| | - Alain Hendlisz
- Institut Jules Bordet, Department of Medicine, Blvd de Waterloo 121, 1000 Brussels, Belgium.
| | - Lissandra Dal Lago
- Institut Jules Bordet, Department of Medicine, Blvd de Waterloo 121, 1000 Brussels, Belgium.
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García-Alfonso P, Muñoz Martín AJ, Ortega Morán L, Soto Alsar J, Torres Pérez-Solero G, Blanco Codesido M, Calvo Ferrandiz PA, Grasso Cicala S. Oral drugs in the treatment of metastatic colorectal cancer. Ther Adv Med Oncol 2021; 13:17588359211009001. [PMID: 33995592 PMCID: PMC8111515 DOI: 10.1177/17588359211009001] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most common forms of cancer, with an estimated 1.36 million new cases and almost 700,000 deaths annually. Approximately 21% of patients with CRC have metastatic disease at diagnosis. The objective of this article is to review the literature on the efficacy and safety of oral drugs available for the treatment of metastatic colorectal cancer (mCRC). Several such drugs have been developed, and fluoropyrimidines are the backbone of chemotherapy in this indication. They exert their antitumour activity by disrupting the synthesis and function of DNA and RNA. Oral fluoropyrimidines include prodrugs capecitabine, tegafur, eniluracil/5-fluorouracil, tegafur/uracil, tegafur/gimeracil/oteracil and trifluridine/tipiracil (FTD/TPI). Oral drugs offer several advantages over injectable formulations, including convenience, flexibility, avoidance of injection-related adverse events (AEs) and, in some circumstances, lower costs. However, oral drugs may not be suitable for patients with gastrointestinal obstruction or malabsorption, they may result in reduced treatment adherence and should not be co-administered with drugs that interfere with absorption or hepatic metabolism. Oral fluoropyrimidines such as capecitabine, as monotherapy or in combination with oxaliplatin, irinotecan or bevacizumab, are as effective as intravenous 5-fluorouracil (5-FU) in first-line treatment of mCRC. Other oral fluoropyrimidines, such as FTD/TPI, are effective in patients with mCRC who are refractory, intolerant or ineligible for 5-FU. In addition, oral fluoropyrimidines are used in adjuvant treatment of mCRC. Regorafenib is an oral multikinase inhibitor used in patients in whom several previous lines of therapy have failed. Frequent AEs associated with oral drugs used in the treatment of CRC include hand-foot syndrome and gastrointestinal and haematological toxicities.
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Affiliation(s)
- Pilar García-Alfonso
- Oncología Médica, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid, 28009, Spain
| | | | - Laura Ortega Morán
- Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Soto Alsar
- Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Huang C, Gu X, Zeng X, Chen B, Yu W, Chen M. Cetuximab versus bevacizumab following prior FOLFOXIRI and bevacizumab in postmenopausal women with advanced KRAS and BRAF wild-type colorectal cancer: a retrospective study. BMC Cancer 2021; 21:30. [PMID: 33413175 PMCID: PMC7789412 DOI: 10.1186/s12885-020-07770-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/26/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND An upgraded understanding of factors (sex/estrogen) associated with survival benefit in advanced colorectal carcinoma (CRC) could improve personalised management and provide innovative insights into anti-tumour mechanisms. The aim of this study was to assess the efficacy and safety of cetuximab (CET) versus bevacizumab (BEV) following prior 12 cycles of fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) plus BEV in postmenopausal women with advanced KRAS and BRAF wild-type (wt) CRC. METHODS Prospectively maintained databases were reviewed from 2013 to 2017 to assess postmenopausal women with advanced KRAS and BRAF wt CRC who received up to 12 cycles of FOLFOXIRI plus BEV inductive treatment, followed by CET or BEV maintenance treatment. The primary endpoints were overall survival (OS), progression-free survival (PFS), response rate. The secondary endpoint was the rate of adverse events (AEs). RESULTS At a median follow-up of 27.0 months (IQR 25.1-29.2), significant difference was detected in median OS (17.7 months [95% confidence interval [CI], 16.2-18.6] for CET vs. 11.7 months [95% CI, 10.4-12.8] for BEV; hazard ratio [HR], 0.63; 95% CI, 0.44-0.89; p=0.007); Median PFS was 10.7 months (95% CI, 9.8-11.3) for CET vs. 8.4 months (95% CI, 7.2-9.6) for BEV (HR, 0.67; 95% CI 0.47-0.94; p=0.02). Dose reduction due to intolerable AEs occurred in 29 cases (24 [24.0%] for CET vs. 5 [4.8%] for BEV; p< 0.001). CONCLUSIONS CET tends to be superior survival benefit when compared with BEV, with tolerated AEs.
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Affiliation(s)
- Chunlong Huang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Xiaoyuan Gu
- Department of Oncology, Shibei Hospital of Shanghai, No. 4500, Goughexin Road, Jing’ an District, Shanghai, 200443 China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Baomin Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
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Battisti NML, Liposits G, De Glas NA, Gomes F, Baldini C, Mohile S. Systemic Therapy of Common Tumours in Older Patients: Challenges and Opportunities. A Young International Society of Geriatric Oncology Review Paper. Curr Oncol Rep 2020; 22:98. [PMID: 32725503 DOI: 10.1007/s11912-020-00958-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Decision-making for systemic treatments in older patients with cancer is difficult because of concerns for decreased organ function, risk of toxicity, limited life expectancy due to comorbidities and the lack of evidence available to guide its management in this population. Here, we review the data on the role of systemic agents for the treatment of common malignancies in this age group. RECENT FINDINGS Evidence on the use of systemic treatments for older patients with cancer is increasing, especially for newer options including immune checkpoint inhibitors and targeted agents that provide comparable benefit in older and younger patients. Nonetheless, the risks for short- and long-term toxicities need to be considered. More research is warranted and represents a unique opportunity to increase the knowledge on cancer treatment for older adults. Healthy, older individuals should be considered for standard systemic treatment options, whereas those at risk based on geriatric assessments require adjusted plans. Geriatric assessments are key for decision-making.
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Affiliation(s)
- Nicolò Matteo Luca Battisti
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,Breast Cancer Research Division, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK.
| | - Gabor Liposits
- Department of Oncology, Regional Hospital West Jutland, Gl Landevej 61, 7400, Herning, Denmark
| | - Nienke Aafke De Glas
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333, Leiden, ZA, Netherlands
| | - Fabio Gomes
- Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Capucine Baldini
- Drug Development Department, Institut Gustave Roussy, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Supriya Mohile
- Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Ave # 704, Rochester, NY, 14642, USA
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MOMENTUM: A Phase I Trial Investigating 2 Schedules of Capecitabine With Aflibercept in Patients With Gastrointestinal and Breast Cancer. Clin Colorectal Cancer 2020; 19:311-318.e1. [PMID: 32631787 DOI: 10.1016/j.clcc.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/16/2020] [Accepted: 05/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although data from preclinical and clinical studies provide a strong rationale for combining capecitabine with anti-angiogenic agents, clinical development of this fluoropyrimidine in combination with aflibercept has lagged behind other treatments. We conducted a nonrandomized, noncomparative, 2-arm, phase I trial to address this unmet need. PATIENTS AND METHODS Patients with chemorefractory gastrointestinal and breast cancer were sequentially recruited into a continuous (Arm A, starting dose 1100 mg/m2/day) or intermittent (Arm B, 2 weeks on/1 week off, starting dose 1700 mg/m2/day) capecitabine dosing arm. Aflibercept was administered at a flat dose of 6 mg/kg every 3 weeks in both arms. A classical 3 + 3, dose-escalation design was used. The primary objective was to establish the maximum tolerated dose, dose-limiting toxicities (DLTs), and recommended dose for phase II trials. RESULTS Thirty-eight eligible patients were recruited of whom 33 were assessable for DLTs (15 in arm A and 18 in arm B). Fourteen had colorectal cancer, 8 gastric cancer, and 11 breast cancer. DLTs included grade 2 hand-foot syndrome, grade 2 anorexia considered unacceptable by the patient, and grade 3 hypertension. The recommended dose for phase II trials for capecitabine was established at 1300 mg/m2/day in Arm A and 2500 mg/m2/day in Arm B with treatment-related grade ≥ 3 adverse events occurring in 47% and 50% of patients, respectively. Among 26 assessable patients, the objective response rate was 15.4% in Arm A and 7.7% in Arm B. CONCLUSION Combining capecitabine with aflibercept is feasible and associated with a manageable safety profile and some anti-tumor activity in patients with chemorefractory gastrointestinal and breast cancer.
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Rogers JE, Eng C. Pharmacotherapeutic considerations for elderly patients with colorectal cancer. Expert Opin Pharmacother 2019; 20:2139-2160. [PMID: 31456458 DOI: 10.1080/14656566.2019.1657826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Oncology care in the elderly presents a dilemma. The majority of cancer cases are diagnosed in the elderly yet they are underrepresented in clinical trials. In addition to limited evidence-based medicine, the elderly is a heterogeneous population filled with pharmacotherapeutic challenges and barriers. Elderly metastatic colorectal cancer (mCRC) treatment decisions encompass these challenges.Areas covered: Treatment based solely on chronological age is an unacceptable practice. Physiologic factors such as function, cognition, comorbidities, polypharmacy, among others must be considered. Oncology guidelines emphasize using a geriatric assessment (GA) as opposed to traditional oncology performance status measures to best identify risks. Our review shines light on these issues as they pertain to elderly unresectable metastatic colorectal cancer (mCRC).Expert opinion: The practical use of GA tools in oncology remain to be determined. Current barriers are the lack of a consistent tool to unify decision-making, provider education, and evidence-based use/outcomes in specific cancers. mCRC antineoplastic data surrounding GAs are scarce, and current mCRC national treatment algorithms are not stratified to encompass GA-driven therapy. Therefore, providers lack clear guidance or practicality of use. We hope mCRC trial designs will abandon age cutoffs and instead place more focus on GAs for inclusion and outcomes.
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Affiliation(s)
- Jane E Rogers
- Department of Pharmacy Clinical Programs, U.T. M.D. Anderson Cancer Center, Houston, TX, USA
| | - Cathy Eng
- Department of Medicine Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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Wells JC, Tu D, Siu LL, Shapiro JD, Jonker DJ, Karapetis C, Simes J, Liu G, Price TJ, Tebbutt NC, O’Callaghan CJ. Outcomes of Older Patients (≥ 70 Years) Treated With Targeted Therapy in Metastatic Chemorefractory Colorectal Cancer: Retrospective Analysis of NCIC CTG CO.17 and CO.20. Clin Colorectal Cancer 2019; 18:e140-e149. [DOI: 10.1016/j.clcc.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 01/10/2023]
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9
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Su J, Lai J, Yang R, Xu B, Zhu Y, Zhao M, Yang C, Liang G. Capecitabine plus bevacizumab versus capecitabine in maintenance treatment for untreated characterised KRAS exon 2 wild-type metastatic colorectal cancer: a retrospective analysis in Chinese postmenopausal women. BMC Gastroenterol 2019; 19:17. [PMID: 30683047 PMCID: PMC6346504 DOI: 10.1186/s12876-018-0916-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/03/2018] [Indexed: 12/16/2022] Open
Abstract
Background Capecitabine plus bevacizumab (CAP-B) maintenance treatment after 6 cycles of capecitabine, oxaliplatin, and bevacizumab (CAPOXB) has demonstrated clinical activity and failure to compromise quality of life in patients with metastatic colorectal cancer (MCC) in a previous phase 3 CAIRO3 study. The objective of this study is to evaluate the efficacy and safety of CAP-B versus CAP in maintenance treatment after 6-cycle CAPOXB induction therapy in Chinese postmenopausal women with untreated characterised KRAS exon 2 wild-type MCC. Methods During 2012–2016, prospectively maintained databases were reviewed to evaluate cohorts with untreated characterised KRAS exon 2 wild-type MCC and stable disease or better after 6-cycle CAPOXB induction treatment. After induction treatment, all patients received either CAP-B or capecitabine (CAP) as maintenance treatment. Median progression-free survival (mPFS) and median overall survival (mOS) were the primary endpoints. Safety was the secondary endpoint. Results A total of 263 women with untreated characterised KRAS exon 2 wild-type MCC and stable disease or better after 6-cycle CAPOXB induction treatment were included for the evaluation of efficacy and safety (CAP-B-treated cohort, n = 130 and CAP-treated cohort, n = 133). The mPFS was 11.5 months (95% confidence interval [CI], 5.6–17.4) and 9.2 months (95% CI, 3.6–14.8) for the CAP-B-treated and CAP-treated cohorts, respectively (HR 0.54, 95% CI 0.32~0.85; P = 0.013). The mOS was 16.2 months (95% CI, 11.4–18.7) and 12.4 months (95% CI, 10.6–15.5) for the CAP-B- and CAP-treated cohorts, respectively (HR 0.72, 95% CI 0.51~0.94; P = 0.022). The CAP-B-treated cohort experienced significantly more grade 3 or 4 diarrhoea (P < 0.001) than the CAP-treated cohort. Conclusions CAP-B maintenance treatment after 6-cycle CAPOX-B in Chinese postmenopausal women with untreated KRAS exon 2 wild-type MCC is poorer tolerated but has a more modest, if any, benefit compared with that of CAP maintenance treatment.
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Affiliation(s)
- Jinsong Su
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road No.1, Erqi District, Zhengzhou, 450052, Henan, China
| | - Jiajie Lai
- Department of Gynaecology and obstetrics, The First Affiliated Hospital, Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Ruikun Yang
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Bo Xu
- Department of thoracic surgery, The First Affiliated Hospital, Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Ying Zhu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China.
| | - Chen Yang
- Department of Physical Examination, The First Affiliated Hospital, Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China.
| | - Guanzhao Liang
- Emergency Department, The First Affiliated Hospital, Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China.
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Koch C, Schwing AM, Herrmann E, Borner M, Diaz-Rubio E, Dotan E, Feliu J, Okita N, Souglakos J, Arkenau HT, Porschen R, Koopman M, Punt CJA, de Gramont A, Tournigand C, Zeuzem S, Trojan J. Bevacizumab-based first-line chemotherapy in elderly patients with metastatic colorectal cancer: an individual patient data based meta-analysis. Oncotarget 2017. [PMID: 29535805 PMCID: PMC5828201 DOI: 10.18632/oncotarget.23475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this meta-analysis was to evaluate efficacy and safety of first-line chemotherapy with or without a monoclonal antibody in elderly patients (≥ 70 years) with metastatic colorectal cancer (mCRC), since they are frequently underrepresented in clinical trials. Results Individual data from 10 studies were included. From a total of 3271 patients, 604 patients (18%) were ≥ 70 years (median 73 years, range 70-88). Of these, 335 patients were treated with a bevacizumab-based first-line regimen and 265 were treated with chemotherapy only. The median PFS was 8.2 vs. 6.5 months and the median OS was 16.7 vs. 13.0 months in patients treated with and without bevacizumab, respectively. The safety profile of bevacizumab in combination with first-line chemotherapy did not differ from published clinical trials. Materials and Methods PubMed and Cochrane Library searches were performed on 29 April 2013 and studies published to this date were included. Authors were contacted to request progression-free survival (PFS), overall survival (OS) data, patient data on treatment regimens, age, sex and potential signs of toxicity in patients ≥ 70 years of age. Conclusions This meta-analysis suggests that the addition of bevacizumab to standard first-line chemotherapy improves clinical outcome in elderly patients with mCRC and is well tolerated.
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Affiliation(s)
- Christine Koch
- Department of Gastroenterology, University Liver and Cancer Centre, Frankfurt, Germany
| | - Anna M Schwing
- Department of Gastroenterology, University Liver and Cancer Centre, Frankfurt, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Markus Borner
- Medical Oncology Institute, Inselspital, Bern, Switzerland
| | | | - Efrat Dotan
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jaime Feliu
- Department of Medical Oncology, La Paz University Hospital, CIBERONC, Madrid, Spain
| | | | - John Souglakos
- Department of Medical Oncology, University Hospital of Heraklion, University of Crete, Crete, Greece
| | | | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Centre, Utrecht, The Netherlands
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Stefan Zeuzem
- Department of Gastroenterology, University Liver and Cancer Centre, Frankfurt, Germany
| | - Joerg Trojan
- Department of Gastroenterology, University Liver and Cancer Centre, Frankfurt, Germany
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11
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Martinelli E, Cardone C, Troiani T, Normanno N, Pisconti S, Sforza V, Bordonaro AR, Rachiglio AM, Lambiase M, Latiano TP, Modoni G, Cordio S, Giuliani F, Biglietto M, Montesarchio V, Barone C, Tonini G, Cinieri S, Febbraro A, Rizzi D, De Vita F, Orditura M, Colucci G, Maiello E, Ciardiello F, Iaffaioli V, Nasti G, Nappi A, Botti G, Tatangelo F, Chicchinelli N, Montrone M, Sebastio A, Guarino T, Simone G, Graziano P, Chiarazzo C, Maggio G, Longhitano L, Manusia M, Cartenì G, Nappi O, Micheli P, Leo L, Rossi S, Cassano A, Tommaselli E, Giordano G, Sponziello F, Marino A, Rinaldi A, Romito S, Muda AO, Lorusso V, Leo S, Barni S, Grimaldi G, Aieta M. Clinical activity and tolerability of FOLFIRI and cetuximab in elderly patients with metastatic colorectal cancer in the CAPRI-GOIM first-line trial. ESMO Open 2017; 1:e000086. [PMID: 28848656 PMCID: PMC5548975 DOI: 10.1136/esmoopen-2016-000086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the cetuximab after progression in KRAS wild-type colorectal cancer patients (CAPRI) trial patients with metastatic colorectal cancer (mCRC) received 5-fluorouracil, folinic acid and irinotecan (FOLFIRI) and cetuximab in first line followed by 5-Fluorouracil, folinic acid, oxaliplatin (FOLFOX) with or without cetuximab until progression. Limited data are available on the efficacy and safety of anti-epidermal growth factor receptor (anti-EGFR) agents on elderly patients with mCRC. In the current study we evaluated the efficacy and safety of FOLFIRI plus cetuximab in age-defined subgroups. METHODS A post-hoc analysis was performed in CAPRI trial patients; outcomes (progression-free survival (PFS), overall response rate (ORR), safety) were analysed by age-groups and stratified according to molecular characterisation. 3 age cut-offs were used to define the elderly population (≥65; ≥70 and ≥75 years). RESULTS 340 patients with mCRC were treated in first line with FOLFIRI plus cetuximab. Among those, 154 patients were >65 years, 86 >70 years and 35 >75 years. Next-generation sequencing (NGS) was performed in 182 patients. Among them, 87 patients were >65 years, 46 >70 and 17 >75. 104 of 182 patients were wild type (WT) for KRAS, NRAS, BRAF, PIK3CA genes. In the quadruple WT group, 51 patients were ≥65 years; 29 were ≥70; 9 were ≥75. Median PFS was similar within the age-subgroups in the intention-to-treat population, NGS cohort and quadruple WT patients, respectively. Likewise, ORR was not significantly different among age-subgroups in the 3 populations. Safety profile was acceptable and similarly reported among all age-groups, with the exception of grade ≥3 diarrhoea (55% vs 25%, p=0.04) and neutropaenia (75% vs 37%, p=0.03) in patients ≥75 years and grade ≥3 fatigue (31% vs 20%, p=0.01) in patients <75 years. CONCLUSIONS Tolerability of cetuximab plus FOLFIRI was acceptable in elderly patients. Similar ORR and PFS were observed according to age-groups. No differences in adverse events were reported among the defined subgroups with the exception of higher incidence of grade ≥3 diarrhoea and neutropaenia in patients ≥75 years and grade ≥3 fatigue in patients <75 years. TRIAL REGISTRATION NUMBER 2009-014041-81.
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Affiliation(s)
- E Martinelli
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy.
| | - C Cardone
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - T Troiani
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - N Normanno
- Cell Biology and Biotherapy Unit, National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy
| | - S Pisconti
- Department of Medical Oncology, Hospital SS. Annunziata, Taranto, Italy
| | - V Sforza
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - A R Bordonaro
- Department of Medical Oncology, Hospital Garibaldi, Nesima, Catania, Italy
| | - A M Rachiglio
- Cell Biology and Biotherapy Unit, National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy; Laboratory of Pharmacogenomics, Centro di Ricerche Oncologiche di Mercogliano (CROM)-National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy
| | - M Lambiase
- Cell Biology and Biotherapy Unit, National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy; Laboratory of Pharmacogenomics, Centro di Ricerche Oncologiche di Mercogliano (CROM)-National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy
| | - T P Latiano
- Department of Medical Oncology, Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
| | - G Modoni
- Department of Medical Oncology, Hospital SS. Annunziata, Taranto, Italy
| | - S Cordio
- Department of Medical Oncology, Hospital Garibaldi, Nesima, Catania, Italy
| | - F Giuliani
- Department of Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari,Italy
| | - M Biglietto
- Department of Medical Oncology, Hospital "A. Cardarelli", Naples, Italy
| | - V Montesarchio
- Department of Medical Oncology, Hospital Monaldi- Azienda Ospedaliera dei Colli, Naples,Italy
| | - C Barone
- Department of Medical Oncology, University Hospital A. Gemelli ,Rome, Italy
| | - G Tonini
- Department of Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - S Cinieri
- Department of Medical Oncology, Hospital A. Perrino, Brindisi, Italy
| | - A Febbraro
- Department of Medical Oncology, Hospital Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | - F De Vita
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - M Orditura
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - G Colucci
- Department of Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari,Italy
| | - E Maiello
- Department of Medical Oncology, Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
| | - F Ciardiello
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
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Moth EB, Vardy J, Blinman P. Decision-making in geriatric oncology: systemic treatment considerations for older adults with colon cancer. Expert Rev Gastroenterol Hepatol 2016; 10:1321-1340. [PMID: 27718755 DOI: 10.1080/17474124.2016.1244003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Colon cancer is common and can be considered a disease of older adults with more than half of cases diagnosed in patients aged over 70 years. Decision-making about treatment with chemotherapy for older adults may be complicated by age-related physiological changes, impaired functional status, limited social supports, concerns regarding the occurrence of and ability to tolerate treatment toxicity, and the presence of comorbidities. This is compounded by a lack of high quality evidence guiding cancer treatment decisions for older adults. Areas covered: This narrative review evaluates the evidence for adjuvant and palliative systemic therapy in older adults with colon cancer. The value of an adequate assessment prior to making a treatment decision is addressed, with emphasis on the geriatric assessment. Guidance in making a treatment decision is provided. Expert commentary: Treatment decisions should consider goals of care, a patient's treatment preferences, and weigh up relative benefits and harms.
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Affiliation(s)
- Erin B Moth
- a Concord Cancer Centre , Concord Repatriation General Hospital , Sydney , Australia.,b Sydney Medical School , University of Sydney , Sydney , Australia
| | - Janette Vardy
- a Concord Cancer Centre , Concord Repatriation General Hospital , Sydney , Australia.,b Sydney Medical School , University of Sydney , Sydney , Australia
| | - Prunella Blinman
- a Concord Cancer Centre , Concord Repatriation General Hospital , Sydney , Australia.,b Sydney Medical School , University of Sydney , Sydney , Australia
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13
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Pinto C, Antonuzzo L, Porcu L, Aprile G, Maiello E, Masi G, Petrelli F, Scartozzi M, Torri V, Barni S. Efficacy and Safety of Bevacizumab Combined With Fluoropyrimidine Monotherapy for Unfit or Older Patients With Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis. Clin Colorectal Cancer 2016; 16:e61-e72. [PMID: 27687553 DOI: 10.1016/j.clcc.2016.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/01/2016] [Accepted: 08/18/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Whether bevacizumab represents a feasible option for the first-line treatment of unfit and elderly patients with metastatic colorectal cancer (mCRC) remains controversial. The present systematic review and meta-analysis evaluated the efficacy and safety data of bevacizumab combined with first-line fluoropyrimidine monochemotherapy for these complex patients. PATIENTS AND METHODS A systematic search of the published data was conducted through May 31, 2016. The random-effects model was used to combine the effect estimates and the I2 index to quantify the between-study heterogeneity unexplained by sampling error. RESULTS We included 3 randomized controlled trials, 4 single-arm phase II trials, and 1 prospective cohort study in the present meta-analysis (n = 782). The monochemotherapy administered was capecitabine in 531 patients (67.9%) and 5-fluorouracil in 251 (32.1%); 500 (63.9%) also received bevacizumab. The median age was 75 years, 441 patients (56.4%) were men, and the Eastern Cooperative Oncology Group performance status was 0 to 1 in 684 patients (87.7%). The combination with bevacizumab produced advantages in terms of both progression-free survival (hazard ratio, 0.52; 95% confidence interval, 0.43-0.64; P < .00001; I2 = 0%) and overall survival (HR, 0.79; 95% CI, 0.64-0.98; P = .03; I2 = 0%). The pooled effect estimates of the randomized controlled trials have been previously reported. As expected, all-grade hypertension (27% vs. 4.9%), bleeding (24% vs. 6.4%), thromboembolic events (10% vs. 5%), and proteinuria (25.6% vs. 8.2%) were more frequent in the bevacizumab combination group. CONCLUSION Adding bevacizumab to first-line fluoropyrimidine monochemotherapy significantly improved progression-free and overall survival in unfit and elderly patients with mCRC, with a manageable safety profile and no unexpected toxicities.
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Affiliation(s)
- Carmine Pinto
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
| | - Lorenzo Antonuzzo
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Luca Porcu
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Giuseppe Aprile
- Department of Medical Oncology, University and General Hospital, Udine, Italy
| | - Evaristo Maiello
- Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Gianluca Masi
- Division of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Fausto Petrelli
- Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Italy
| | - Mario Scartozzi
- Department of Oncology, Università di Cagliari-Azienda Ospedaliero Universitaria, Monserrato, Italy
| | - Valter Torri
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Sandro Barni
- Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Italy
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Munemoto Y, Kanda M, Ishibashi K, Hata T, Kobayashi M, Hasegawa J, Fukunaga M, Takagane A, Otsuji T, Miyake Y, Nagase M, Sakamoto J, Matsuoka M, Oba K, Mishima H. Capecitabine and oxaliplatin combined with bevacizumab are feasible for treating selected Japanese patients at least 75 years of age with metastatic colorectal cancer. BMC Cancer 2015; 15:786. [PMID: 26497654 PMCID: PMC4619505 DOI: 10.1186/s12885-015-1712-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 10/08/2015] [Indexed: 02/07/2023] Open
Abstract
Background Although number of elderly patients with metastatic colorectal cancer (mCRC) is rapidly increasing, this population is often underrepresented in clinical trials. Recently, a phase II trial demonstrated that capecitabine and oxaliplatin (XELOX) combined with bevacizumab XELOX plus bevacizumab was effective and well tolerated by elderly patients with mCRC who reside in Western countries. The aim of this study was to evaluate the safety and efficacy of XELOX plus bevacizumab for Japanese patients aged ≥75 years with mCRC. Methods This prospective, open-label phase II trial recruited patients aged ≥75 years with previously untreated mCRC between March 2010 and January 2012. Treatment consisted of 7.5 mg/kg of intravenous bevacizumab and 130 mg/m2 of oxaliplatin on day 1 of each cycle combined with 2000 mg/m2 of oral capecitabine per day on days 1–14 of each cycle. Treatment was repeated every 3 weeks until disease progression or termination of the study. The primary endpoint was progression-free survival; the secondary endpoints were toxicity, overall response rate, time-to-treatment failure, and overall survival. Results Thirty-six patients (male 58 %; median age 78 years; colon cancer 67 %) met all eligibility criteria and received at least one course of the planned treatment. The median time-to-treatment failure was 7.0 months. Twelve patients (33.3 %) experienced adverse effects (AEs) ≥ grade 3 and frequent AEs ≥ grade 3, including neutropenia (22.2 %) and neuropathy (13.9 %). Hypertension was the most frequent AE ≥ grade 3 associated with bevacizumab (11.1 %). Low baseline creatinine clearance associated significantly with the incidence of AEs ≥ grade 3. Response and disease control rates were 55.6 and 91.7 %, respectively. Median progression-free and overall survival times were 11.7 months (95 % confidence interval, 8.0–13.4 months) and 22.9 months, respectively. Conclusion XELOX combined with bevacizumab was well tolerated by selected Japanese patients aged ≥75 years with mCRC patients, and controlled clinical trials are now required to determine the survival benefit. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1712-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Keiichiro Ishibashi
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
| | - Taishi Hata
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kohasu, Japan.
| | | | - Mutsumi Fukunaga
- Department of Surgery, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan.
| | - Akinori Takagane
- Surgical Division, Hakodate Goryoukaku Hospital, Hakodate, Japan.
| | - Toshio Otsuji
- Department of Internal Medicine, Dongo Hospital, Yamatotakada, Nara, Japan.
| | - Yasuhiro Miyake
- Department of Surgery, Minoh City Hospital Gastrointestinal Research Center, Minoh, Osaka, Japan.
| | - Michitaka Nagase
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan.
| | | | | | - Koji Oba
- Department of Biostatistics, School of Public Health, Tokyo University Graduate School of Medicine, Tokyo, Japan. .,Interfaculty Initiative in Information Studies, Tokyo University, Tokyo, Japan.
| | - Hideyuki Mishima
- Unit of Cancer Center, Aichi Medical University, Nagakute, Japan.
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15
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Ozcelik M, Odabas H, Ercelep O, Yuksel S, Mert AG, Aydin D, Surmeli H, Isik D, Isik S, Oyman A, Oven Ustaalioglu BB, Aliustaoglu M, Gumus M. The efficacy and safety of capecitabine plus bevacizumab combination as first-line treatment in elderly metastatic colorectal cancer patients. Clin Transl Oncol 2015; 18:617-24. [PMID: 26459249 DOI: 10.1007/s12094-015-1408-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/05/2015] [Indexed: 11/24/2022]
Abstract
AIM The optimal treatment in older persons with metastatic colorectal cancer (mCRC) is complicated by a lack of general agreement. The aim of this study was to evaluate the activity of bevacizumab plus capecitabine combination in elderly mCRC patients who were not suitable for chemotherapy with irinotecan and oxaliplatin-containing regimens. MATERIALS AND METHODS Seventy years and older patients with metastatic colorectal carcinoma were included in this retrospective study. Bevacizumab was administered at a dose of 7.5 mg/kg on day 1 as an intravenous (IV) infusion over 30-90 min every 21 days, and capecitabine was prescribed at 1000 mg/m(2) twice daily on days 1-14 of the same 21-day schedule. RESULTS Eighty-two consecutive patients (47 men, 35 women) were included in the study. The mean age was 75.5 (SD 3.9, range 70-87). Half of the patients were older than 75 years. There were 55 patients (67.1 %) with a good Eastern Cooperative Oncology Group (ECOG) performance status (PS: 0-1) and the remaining 27 patients (32.9 %) had a poor ECOG performance status (PS: 2). With a median follow-up period of 18.5 months, the median progression-free survival (PFS) was 10 months (95 % CI, 7.8-12.1) and the median OS was 25 months (95 % CI, 18.6-31.3). The main toxicities recorded were non-hematological. Thirty-one patients (37 %) experienced grade 3/4 adverse events, the most common being hand-foot syndrome (9.8 %). No fatal toxicity resulting from this regimen was recorded. CONCLUSIONS Considering the toxicity profile and survival outcomes, the combination regimen of capecitabine and bevacizumab is a potentially feasible treatment option in elderly mCRC patients.
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Affiliation(s)
- M Ozcelik
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34865, Istanbul, Turkey.
| | - H Odabas
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34865, Istanbul, Turkey
| | - O Ercelep
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34865, Istanbul, Turkey
| | - S Yuksel
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34865, Istanbul, Turkey
| | - A G Mert
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34865, Istanbul, Turkey
| | - D Aydin
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34865, Istanbul, Turkey
| | - H Surmeli
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34865, Istanbul, Turkey
| | - D Isik
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34865, Istanbul, Turkey
| | - S Isik
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34865, Istanbul, Turkey
| | - A Oyman
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34865, Istanbul, Turkey
| | - B B Oven Ustaalioglu
- Department of Medical Oncology, Haydarpasa Numune Education and Research Hospital, 34668, Istanbul, Turkey
| | - M Aliustaoglu
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34865, Istanbul, Turkey
| | - M Gumus
- Department of Medical Oncology, Bezmialem Vakif University School of Medicine, 34093, Istanbul, Turkey
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Feliu J, Salud A, Safont MJ, García-Girón C, Aparicio J, Losa F, Bosch C, Escudero P, Casado E, Jorge M, Bohn U, Pérez-Carrión R, Carmona A, Custodio AB, Maurel J. Correlation of hypertension and proteinuria with outcome in elderly bevacizumab-treated patients with metastatic colorectal cancer. PLoS One 2015; 10:e0116527. [PMID: 25602286 PMCID: PMC4300229 DOI: 10.1371/journal.pone.0116527] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/09/2014] [Indexed: 12/18/2022] Open
Abstract
Background Studies suggest a relationship between hypertension and outcome in bevacizumab-treated patients with metastatic colorectal cancer (mCRC). We performed a retrospective analysis of two phase II studies (BECA and BECOX) to determine if hypertension and proteinuria predict outcome in elderly patients with mCRC treated with bevacizumab. Patients and Methods Patients ≥70 years of age received either capecitabine 1250 mg/m2 bid days 1–14 + bevacizumab 7.5 mg/kg day 1 every 21 days (BECA study) or capecitabine 1000 mg/m2 bid days 1–14 with bevacizumab 7.5 mg/kg and oxaliplatin 130 mg/m2 day 1 (BECOX study). The primary objective was to correlate hypertension and proteinuria with overall response rate (ORR), time to progression (TTP) and overall survival (OS). Secondary objectives included identification of risk factors associated with the development of hypertension and proteinuria and determining whether development of hypertension or proteinuria in the first 2 cycles was related to ORR, disease-control rate (DCR), TTP or OS. Results In total, 127 patients (median age 75.5 years) were included in the study. Hypertension correlated with DCR and OS; proteinuria correlated with ORR and DCR. Proteinuria or hypertension in the first 2 cycles did not correlate with efficacy. Risk factors for hypertension were female gender (odds ratio [OR] 0.241; P = 0.011) and more bevacizumab cycles (OR 1.112; P = 0.002); risk factors for proteinuria were diabetes (OR 3.869; P = 0.006) and more bevacizumab cycles (OR 1.181; P<0.0001). Multivariate analysis identified as having prognostic value: baseline lactate dehydrogenase, haemoglobin, number of metastatic lesions and DCR. Conclusion This analysis of two phase II studies suggests that hypertension is significantly correlated with OS but not with ORR and TTP, whereas proteinuria is correlated with ORR but not with OS and TTP. Both hypertension and proteinuria are associated with the duration of bevacizumab treatment and do not represent an independent prognostic factor.
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Affiliation(s)
- Jaime Feliu
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, Spain
- * E-mail:
| | - Antonieta Salud
- Servicio de Oncología Médica, Hospital Arnau de Vilanova, Lleida, Spain
| | - Maria J. Safont
- Servicio de Oncología Médica, Hospital Universitario Clinico de Valencia, Valencia, Spain
| | | | - Jorge Aparicio
- Servicio de Oncología Médica, Hospital La Fe de Valencia, Valencia, Spain
| | - Ferran Losa
- Servicio de Oncología Médica, Hospital de La Creu Roja de L´Hospitalet, Barcelona, Spain
| | - Carlos Bosch
- Servicio de Oncología Médica, Hospital General de Valencia, Valencia, Spain
| | - Pilar Escudero
- Servicio de Oncología Médica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Enrique Casado
- Servicio de Oncología Médica, Hospital Infanta Sofía, Madrid, Spain
| | - Monica Jorge
- Servicio de Oncología Médica, Complejo Hospitalario Xeral Cies, Vigo, Pontevedra, Spain
| | - Uriel Bohn
- Servicio de Oncología Médica, Hospital Universitario de Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | - Ramon Pérez-Carrión
- Servicio de Oncología Médica, Hospital Universitario Quiron Madrid, Madrid, Spain
| | - Alberto Carmona
- Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Messeguer, Murcia, Spain
| | - Ana B. Custodio
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, Spain
| | - Joan Maurel
- Servicio de Oncología Médica, Hospital Clinic i Provincial de Barcelona, Barcelona, Spain
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Ahmed S, Pahwa P, Fields A, Chandra-Kanthan S, Iqbal N, Zaidi A, Reeder B, Plaza FA, Zhu T, Leis A. Predictive Factors of the Use of Systemic Therapy in Stage IV Colorectal Cancer: Who Gets Chemotherapy? Oncology 2015; 88:289-97. [DOI: 10.1159/000368245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/25/2014] [Indexed: 11/19/2022]
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Crosara Teixeira M, Marques DF, Ferrari AC, Alves MFS, Alex AK, Sabbaga J, Hoff PM, Riechelmann RP. The effects of palliative chemotherapy in metastatic colorectal cancer patients with an ECOG performance status of 3 and 4. Clin Colorectal Cancer 2014; 14:52-7. [PMID: 25442812 DOI: 10.1016/j.clcc.2014.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/15/2014] [Accepted: 09/10/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although chemotherapy is standard for patients with mCRC and ECOG PS of 0/1, the real benefit for patients with ECOG PS > 2 remains uncertain, because they are generally excluded from clinical trials. Our objectives were to compare the survival and safety of ECOG PS 3/4 patients who were administered chemotherapy with those who received BSC only. PATIENTS AND METHODS We retrospectively analyzed all consecutive mCRC patients who started first-line chemotherapy at our institution in a 4-year period. A multivariable Cox regression model was used to adjust for prognostic factors and logistic regression, to identify predictive factors of Grade 3/4 toxicity. RESULTS From June 2008 to June 2012, 240 consecutive patients were included: 100 (41.7%) had an ECOG PS of 0/1, 75 (31.3%) ECOG PS of 2, and 65 (27%) ECOG PS of 3/4. Median survival for patients treated with chemotherapy was 18.4 months for patients with ECOG PS of 0/1, 10.8 months for those with ECOG PS of 2, and 6.8 months for patients with ECOG PS of 3/4. Among those with ECOG PS of 3/4, chemotherapy use led to a nonsignificant survival gain (median, 6.8 vs. 2.3 months for BSC; P = .13). Factors significantly associated with worse survival in an adjusted analysis were right-sided tumors (hazard ratio [HR], 2.97; P = .005) and ECOG PS status (ECOG PS 2 vs. 0/1; HR, 1.67; P = .025, and ECOG PS 3/4 vs. 0/1; HR, 2.67; P < .0001). The rate of Grade ≥ 3 toxicities during the first cycle did not differ significantly across ECOG groups; likely because 40% of ECOG PS 3/4 patients received upfront dose-reduced therapy. The rates of treatment-related hospitalization were similar across all ECOG groups. All deaths were disease-associated. CONCLUSION Our retrospective study suggests that chemotherapy might benefit selected mCRC patients with poor PS. With up-front dose reduction and close monitoring for toxicity, the risk of serious adverse events is minimized.
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Affiliation(s)
- Marcela Crosara Teixeira
- Disciplina de Radiologia e Oncologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Centro de Oncologia, Hospital Sírio Libanes, São Paulo, Brazil.
| | - Daniel Fernandes Marques
- Disciplina de Radiologia e Oncologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Centro de Oncologia, Hospital Sírio Libanes, São Paulo, Brazil
| | - Anezka Celis Ferrari
- Disciplina de Radiologia e Oncologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Centro de Oncologia, Hospital Sírio Libanes, São Paulo, Brazil
| | - Michel Fabiano Silva Alves
- Disciplina de Radiologia e Oncologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Alexandra Khichfy Alex
- Disciplina de Radiologia e Oncologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Jorge Sabbaga
- Disciplina de Radiologia e Oncologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Centro de Oncologia, Hospital Sírio Libanes, São Paulo, Brazil
| | - Paulo M Hoff
- Disciplina de Radiologia e Oncologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Centro de Oncologia, Hospital Sírio Libanes, São Paulo, Brazil
| | - Rachel P Riechelmann
- Disciplina de Radiologia e Oncologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Mitry E, Walter T, Baudin E, Kurtz JE, Ruszniewski P, Dominguez-Tinajero S, Bengrine-Lefevre L, Cadiot G, Dromain C, Farace F, Rougier P, Ducreux M. Bevacizumab plus capecitabine in patients with progressive advanced well-differentiated neuroendocrine tumors of the gastro-intestinal (GI-NETs) tract (BETTER trial)--a phase II non-randomised trial. Eur J Cancer 2014; 50:3107-15. [PMID: 25454413 DOI: 10.1016/j.ejca.2014.10.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/26/2014] [Accepted: 10/01/2014] [Indexed: 12/11/2022]
Abstract
AIM OF THE STUDY Gastro-intestinal neuroendocrine tumours (GI-NETs) are chemotherapy-resistant tumours. Bevacizumab, an inhibitor of vascular endothelial growth factor (VEGF), has shown promising results in several phase II trials of gastro-entero-pancreatic-NETs. We assessed bevacizumab combined with capecitabine, specifically in GI-NET patients. PATIENTS AND METHODS BEvacizumab in The Treament of neuroEndocrine tumoRs (BETTER) was a multicentre, open-label, non-randomised, two-group phase II trial. Here we present the group of patients with progressive, metastatic, well-differentiated GI-NETs. Patients Eastern Cooperative Oncology Group-performance status (ECOG-PS)⩽2, Ki-67 proliferation rate <15% and no prior systemic chemotherapy were treated with bevacizumab (7.5 mg/kg/q3w) and capecitabine (1000 mg/m2 twice daily, orally d1-14, resumed on d22) for 6-24 months. The primary end-point was progression-free survival (PFS); secondary end-points included overall survival (OS), response rate, safety and quality of life. RESULTS Of the 49 patients included, 53% were men, median age was 60 years (41-82), primary tumour site was ileal in 82% patients and Ki-67 was <15% in 48 patients and not available for one patient. After a maximum of 24 month follow-up per patient, the median PFS by investigator assessment was 23.4 months [95% confidence interval (CI): 13.2; not reached] and the overall disease control rate was 88% (18% partial response, 70% stable disease). The 2-year survival rate was 85%. Median OS was not reached. The most frequent grade 3-4 adverse events were hypertension (31%), diarrhoea (14%) and hand-foot syndrome (10%). CONCLUSION The combination of bevacizumab and capecitabine showed clinical activity and a manageable safety profile in the treatment of GI-NETs that warrant confirmation in a randomised phase III trial.
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Affiliation(s)
- Emmanuel Mitry
- Medical Oncology Department, Curie Institute, Paris, France.
| | - Thomas Walter
- Medical Oncology Department, Edouard Herriot Hospital, Lyon, France.
| | - Eric Baudin
- Nuclear Medicine and Endocrine Oncology Department, Gustave Roussy Institute, Villejuif, France.
| | - Jean-Emmanuel Kurtz
- Hematology and Oncology Department, University Hospital, Strasbourg, France.
| | - Philippe Ruszniewski
- Gastroenterology and Pancreatology Department, Beaujon Hospital, Clichy, France.
| | | | | | - Guillaume Cadiot
- Hepato-Gastroenterology and Digestive Oncology Department, Robert Debré Hospital, Reims, France.
| | - Clarisse Dromain
- Radio Diagnostic Department, Gustave Roussy Institute, Villejuif, France.
| | - Françoise Farace
- Laboratory of Translational Research, Gustave Roussy Institute, Villejuif, France.
| | - Philippe Rougier
- Hepato-Gastroenterology and Digestive Oncology Department, Georges Pompidou European Hospital, Université Paris V, Paris, France.
| | - Michel Ducreux
- Gastrointestinal Oncology Department, Gustave Roussy Institute, Villejuif, France.
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20
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Ward P, Hecht JR, Wang HJ, Dichmann R, Liem AK, Chan D, Patel R, Hu EH, Tchekmedyian NS, Wainberg ZA, Naeim A. Physical function and quality of life in frail and/or elderly patients with metastatic colorectal cancer treated with capecitabine and bevacizumab: An exploratory analysis. J Geriatr Oncol 2014; 5:368-75. [DOI: 10.1016/j.jgo.2014.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/16/2014] [Accepted: 05/31/2014] [Indexed: 12/14/2022]
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21
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Thakkar JP, McCarthy BJ, Villano JL. Age-specific cancer incidence rates increase through the oldest age groups. Am J Med Sci 2014; 348:65-70. [PMID: 24805784 PMCID: PMC4119927 DOI: 10.1097/maj.0000000000000281] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND In the United States, from 2005 to 2009, nearly 8% of all cancers diagnosed and 15% of cancer deaths occurred in individuals aged 85 years and older (85+ age group). With the aging of the U.S. population, an analysis of incidence of cancer in the elderly population may provide information for clinical care and resource allocation. MATERIALS AND METHODS Previously reported data were retrieved from the Surveillance Epidemiology and End Results (SEER) 18 Registry for years 2000 to 2010 and Central Brain Tumor Registry of the United States (CBTRUS) for years 2004 to 2008. Cancers included invasive cases only, except for nonmalignant meningiomas, and rates were per 100,000. RESULTS The age-specific cancer incidence rate (IR) increases with age until a decrease in the 85+ age group. IR for all cancers combined for this age group was 2,317 per 100,000. Statistically, males had significantly higher IR compared with females (3,194 versus 1,911 [P≤0.0001]). Blacks had an IR similar to whites (2,255 versus 2,340 [P=0.12]). Despite a drop in the overall IR in this oldest age group, IR for certain cancers continued to increase. Among these cancers, gastrointestinal cancers like colorectal, pancreatic and stomach had the highest incidence and mortality rates. CONCLUSIONS This study contributes to measuring cancer burden in the oldest old population. In certain cancers, including meningiomas, the IR continues to rise with advancing age. Management of cancer in elderly is challenging and screening persons in the 85+ age group for frailty very thoroughly may help guide decisions of palliative versus aggressive therapies.
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Affiliation(s)
- Jigisha P Thakkar
- Department of Medicine and Neurology (JPT, JLV), University of Kentucky, Lexington, Kentucky; and Department of Epidemiology/Biostatistics (BJM), University of Illinois Medical Center, Chicago, Illinois
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22
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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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Aguado C, García-Paredes B, Sotelo MJ, Sastre J, Díaz-Rubio E. Should capecitabine replace 5-fluorouracil in the first-line treatment of metastatic colorectal cancer? World J Gastroenterol 2014; 20:6092-6101. [PMID: 24876731 PMCID: PMC4033448 DOI: 10.3748/wjg.v20.i20.6092] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/13/2014] [Accepted: 03/19/2014] [Indexed: 02/06/2023] Open
Abstract
Fluoropyrimidines play a central role in the first-line treatment of metastatic colorectal cancer. Our aim was to review whether capecitabine was a safer, non-inferior, economically superior and more convenient alternative to 5-fluorouracil. Capecitabine has previously been compared to 5-fluorouracil-either as a monotherapy or in combination with oxaliplatin, irinotecan, or biological drugs-and has been found to have comparable efficacy and safety profiles. Furthermore, pharmacoeconomic data and patients’ preferences for oral chemotherapy further favor capecitabine. Therefore, capecitabine appears to be an effective and safe alternative to fluorouracil in the first-line treatment of metastatic colorectal cancer.
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The role of antiangiogenic agents in the treatment of patients with advanced colorectal cancer according to K-RAS status. Angiogenesis 2014; 17:805-21. [PMID: 24793846 DOI: 10.1007/s10456-014-9433-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 04/21/2014] [Indexed: 12/30/2022]
Abstract
Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer worldwide. Recently, it has been found that about 40 % of patients with CRC have mutations in the K-RAS gene. Several clinical trials have showed that patients with metastatic colorectal cancer (mCRC) who present tumour-promoting mutations in signalling pathways involving the epidermal growth factor receptor (EGFR), which includes activating K-RAS mutations, do not respond to anti-EGFR drugs such as panitumumab and cetuximab. Hence, K-RAS status is now considered an important negative predictive factor for response to anti-EGFR drugs. Moreover, K-RAS status seems to have also a prognostic role in CRC, but this fact is somewhat controversial. Activity of antiangiogenic agents seems not to be influenced by K-RAS gene status. Tumour angiogenesis has attracted interest in attempts to improve the management of mCRC. The vascular endothelial growth factor (VEGF) pathway is fundamental to the regulation of angiogenesis, and research has focused on developing agents that selectively target it. In this way, the anti-VEGF antibody bevacizumab in combination with chemotherapy has provided important clinical benefits in terms of response rate, progression-free survival and overall survival to patients with mCRC. Efficacy data of bevacizumab in K-RAS wild-type patients seem to be comparable with the efficacy data observed with anti-EGFR therapies in a cross-trial comparison. Although there is a lack of prospective and randomized data in this setting, the combination of chemotherapy plus antiangiogenic agents could be considered as an effective alternative for the treatment of mCRC with independence of K-RAS gene status. Here, we review the available data we have in the literature of the use of antiangiogenic strategies in the treatment of mCRC nowadays.
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Phase II study of first-line chemotherapy with uracil-tegafur plus oral leucovorin in elderly (≥75 years) Japanese patients with metastatic colorectal cancer: SGOSG-CR0501 study. Int J Clin Oncol 2014; 20:111-6. [PMID: 24553862 DOI: 10.1007/s10147-014-0675-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 01/30/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oral uracil-tegafur and leucovorin (UFT/LV) therapy for elderly patients with metastatic colorectal cancer (mCRC) requires careful handling in Western countries because of a high incidence (≥20 %) of grade 3 diarrhea. However, its efficacy and safety for elderly Asian patients have not been investigated. METHODS In this multicenter cooperative phase II study, the eligibility criteria were: age of 75 years or older, no prior chemotherapy, and histologically confirmed colorectal cancer with one or more measurable lesions. UFT 300 mg/m(2)/day and LV 75 mg/day were administered orally for 28 days followed by a 7-day rest period. RESULTS Twenty-one patients were enrolled in this study (prior to study termination after approval of bevacizumab), and all patients were eligible for efficacy and safety analysis. The median age was 79 years (range, 75-83 years). The majority of patients (95 %) had ECOG Performance Status 0 or 1. The overall response rate was 33 % (95 % confidence interval [CI], 18-53 %). The median progression-free and overall survivals were 5.3 months (95 % CI 4.0-7.9 months) and 18 months (95 % CI 13-21 months), respectively. Grade 3 or greater adverse events included anorexia (10 %), diarrhea (10 %), and leukopenia (5 %). These results were compatible with those seen in Japanese patients in a previous bridging study between Japan and the US, in which patients under 75 years old were evaluated. CONCLUSIONS UFT/LV therapy was safe and feasible in elderly Japanese patients with mCRC, and further study of UFT/LV therapy in combination with bevacizumab is warranted.
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26
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Benavides M, Berciano-Guerrero M. Elderly patients with metastatic colorectal cancer: overall issues and first-line chemotherapy options. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY The aging phenomenon is resulting in an ever greater incidence of colorectal cancer (CRC) in the elderly. Chronologic age is not the best or only way to define elderly patients because aging varies greatly. Comprehensive geriatric assessment has proved beneficial for more appropriate therapeutic options although its influence on treatment decisions and outcomes remains to be validated. Fit elderly patients with metastatic CRC derive similar benefits to their younger counterparts, but only one Phase III trial exists to define the best treatment. New strategies such as maintenance therapies, which are particularly appropriate in these patients, are needed. As very few data are available for the vulnerable/frail elderly population, it is important to better define these terms and the efficacy (if any) of treatment modalities in this group. Translational research in geriatric oncology must be improved in this heterogeneous population to identify biological and clinical correlates of cancer and aging, ameliorating personalized treatment in elderly metastatic CRC patients.
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Affiliation(s)
- Manuel Benavides
- Medical Oncology Department, Hospital Regional Universitario Carlos Haya, Málaga, Spain
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27
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Uchima Y, Nishii T, Iseki Y, Ishii M, Hiramatsu S, Iwauchi T, Morimoto J, Kosaka K, Tei S, Takeuchi K. Retrospective analysis of capecitabine and oxaliplatin (XELOX) plus bevacizumab as a first-line treatment for Japanese patients with metastatic colorectal cancer. Mol Clin Oncol 2013; 2:134-138. [PMID: 24649322 DOI: 10.3892/mco.2013.205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 09/11/2013] [Indexed: 11/06/2022] Open
Abstract
XELOX plus bevacizumab is an effective treatment strategy and has a manageable tolerability profile when administered to Japanese patients with metastatic colorectal cancer (mCRC). In this study, we retrospectively reviewed cases in which XELOX plus bevacizumab were administered in order to evaluate its efficacy and safety in clinical practice. In total, 40 patients with mCRC who presented at Fuchu Hospital received XELOX plus bevacizumab as a first-line treatment between September, 2009 and April, 2012. Eligible patients had histologically confirmed mCRC. XELOX consisted of a 2-h intravenous infusion of oxaliplatin 130 mg/m2 on day 1 plus oral capecitabine 1,000 mg/m2 twice daily for 2 weeks of a 3-week cycle. Overall survival (OS) and survival benefit were analyzed when patients continued with XELOX plus bevacizumab beyond disease progression. The median progression-free survival (PFS) was 290 days [95% confidence interval (CI): 222-409 days] and the median OS was 816 days (95% CI: 490 days-not calculated). The response rate (RR; complete plus partial response) was 67.5%, and the disease control rate (RR plus stable disease) was 90%. The most common adverse events observed following administration of XELOX plus bevacizumab were neurosensory toxicity (82.5%), anorexia (50%), hypertension (45%) and a decrease in the platelet count (40%). The most common grade 3/4 adverse events were neurosensory toxicity (15%) and fatigue (15%). In conclusion, XELOX plus bevacizumab may be considered a routine first-line treatment option for patients with mCRC. Notably, the combination of capecitabine and bevacizumab was safe with an acceptable toxicity profile and induced a significant rate of disease control.
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Affiliation(s)
- Yasutake Uchima
- Department of Surgery, Fuchu Hospital, Izumi, Osaka 5940076, Japan
| | - Takafumi Nishii
- Department of Surgery, Fuchu Hospital, Izumi, Osaka 5940076, Japan
| | - Yasuhito Iseki
- Department of Surgery, Fuchu Hospital, Izumi, Osaka 5940076, Japan
| | - Mariko Ishii
- Department of Surgery, Fuchu Hospital, Izumi, Osaka 5940076, Japan
| | | | - Takehiko Iwauchi
- Department of Surgery, Fuchu Hospital, Izumi, Osaka 5940076, Japan
| | - Junya Morimoto
- Department of Surgery, Fuchu Hospital, Izumi, Osaka 5940076, Japan
| | - Kinshi Kosaka
- Department of Surgery, Fuchu Hospital, Izumi, Osaka 5940076, Japan
| | - Seika Tei
- Department of Surgery, Fuchu Hospital, Izumi, Osaka 5940076, Japan
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Stein A, Kretzschmar A, Behringer D, Wolff T, Zimber J, Hegewisch-Becker S, Kettner E, Pflüger KH, Kirsch A, Arnold D. Capecitabine and bevacizumab for non-resectable metastatic colorectal cancer patients: final results from phase II AIO KRK 0105 trial. BMC Cancer 2013; 13:454. [PMID: 24090011 PMCID: PMC3850951 DOI: 10.1186/1471-2407-13-454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/02/2013] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Current guidelines recommend treatment with capecitabine and bevacizumab for patients (pts) with non-resectable metastatic colorectal cancer (mCRC), although clinical data in this particular patient group are lacking. METHODS Previously untreated patients with non-resectable mCRC were to receive capecitabine (1,250 mg/sqm bid d1-14 oral) and bevacizumab (7.5 mg/kg i.v.) every 3 weeks. Progression-free survival (PFS) was the primary endpoint. Secondary endpoints include overall survival (OS), objective response rate (ORR) and toxicity. RESULTS 82 pts were included: 40 female, median age 70 (range 50-86). ECOG PS 0/1/2 was 38/52/10%, respectively. Synchronous metastases were present in 58 pts. 16 pts had primary tumor in situ. Median treatment duration was 4.1 months (6 cycles). Toxicity was generally mild. ORR was 38%, with 5 complete and 23 partial responses. Median PFS was 7.0 months [95% CI (5.0-9.1)] and OS 17.9 months [95% CI (14.6-21.6)]. Second- and third-line systemic therapy was given to 57% and 33% of pts, respectively. CONCLUSIONS Besides the favourable tolerability, PFS and OS were shorter than reported by other trials. Careful patient selection for upfront capecitabine and bevacizumab is essential.
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Affiliation(s)
- Alexander Stein
- Tumor Biology Center Freiburg, Breisacher Str, 117, 79106 Freiburg, Germany.
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Cunningham D, Lang I, Marcuello E, Lorusso V, Ocvirk J, Shin DB, Jonker D, Osborne S, Andre N, Waterkamp D, Saunders MP. Bevacizumab plus capecitabine versus capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer (AVEX): an open-label, randomised phase 3 trial. Lancet Oncol 2013; 14:1077-1085. [PMID: 24028813 DOI: 10.1016/s1470-2045(13)70154-2] [Citation(s) in RCA: 453] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Elderly patients are often under-represented in clinical trials of metastatic colorectal cancer. We aimed to assess the efficacy and safety of bevacizumab plus capecitabine compared with capecitabine alone in elderly patients with metastatic colorectal cancer. METHODS For this open-label, randomised phase 3 trial, patients aged 70 years and older with previously untreated, unresectable, metastatic colorectal cancer, who were not deemed to be candidates for oxaliplatin-based or irinotecan-based chemotherapy regimens, were randomly assigned in a 1:1 ratio via an interactive voice-response system, stratified by performance status and geographical region. Treatment consisted of capecitabine (1000 mg/m(2) orally twice a day on days 1-14) alone or with bevacizumab (7·5 mg/kg intravenously on day 1), given every 3 weeks until disease progression, unacceptable toxic effects, or withdrawal of consent. Efficacy analyses were based on the intention-to-treat population. The primary endpoint was progression-free survival. The trial is registered with ClinicalTrials.gov, number NCT00484939. FINDINGS From July 9, 2007, to Dec 14, 2010, 280 patients with a median age of 76 years (range 70-87) were recruited from 40 sites across ten countries. Patients were randomly assigned to receive either bevacizumab plus capecitabine (n=140) or capecitabine only (n=140). Progression-free survival was significantly longer with bevacizumab and capecitabine than with capecitabine alone (median 9·1 months [95% CI 7·3-11·4] vs 5·1 months [4·2-6·3]; hazard ratio 0·53 [0·41-0·69]; p<0·0001). Treatment-related adverse events of grade 3 or worse occurred in 53 (40%) patients in the combination group and 30 (22%) in the capecitabine group, and treatment-related serious adverse events in 19 (14%) and 11 (8%) patients. The most common grade 3 or worse adverse events of special interest for bevacizumab or chemotherapy were hand-foot syndrome (21 [16%] vs nine [7%]), diarrhoea (nine [7%] vs nine [7%]), and venous thromboembolic events (11 [8%] vs six [4%]). Treatment-related deaths occurred in five patients in the combination group and four in the capecitabine group. The most common any-grade adverse event of special interest for bevacizumab was haemorrhage (34 [25%] vs nine [7%]). INTERPRETATION The combination of bevacizumab and capecitabine is an effective and well-tolerated regimen for elderly patients with metastatic colorectal cancer. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
| | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | | | - Vito Lorusso
- National Cancer Institute Giovanni Paolo II, Bari, Italy
| | - Janja Ocvirk
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Dong Bok Shin
- Division of Haematology and Oncology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, South Korea
| | - Derek Jonker
- Department of Medical Oncology, The Ottawa Hospital, Ottawa, ON, Canada
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Leo S, Accettura C, Gnoni A, Licchetta A, Giampaglia M, Mauro A, Saracino V, Carr BI. Systemic treatment of gastrointestinal cancer in elderly patients. J Gastrointest Cancer 2013; 44:22-32. [PMID: 23150086 DOI: 10.1007/s12029-012-9447-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Gastrointestinal cancer (GI) incidence increases with each decade of life and is the leading cause of death in patients aged >70 years. Nevertheless, elderly patients are often excluded or underrepresented in clinical trials. We performed a review of current recommendations in the management of GI elderly cancer patients. METHODS A comprehensive literature review was performed analyzing data about several meta-analysis and studies regarding chemotherapeutic regimens in elderly patients with colorectal and gastroesophageal cancers. RESULTS Most of the studies demonstrated that the elderly experience the same advantages and toxicities from chemotherapy as younger individuals despite the fact that the data reviewed in this article provide evidence that elderly with GI cancers are underrepresented in clinical trials and few trials are conducted addressing the different risks and aims in older population. Each individual should be assessed for an appropriate regimen of treatment in the adjuvant or metastatic gastrointestinal cancer setting, and the decision of how to treat elderly must incorporate goals and preferences of the patient after a careful discussion of risks and benefits. CONCLUSION Chronological age alone is not a sufficient factor to withhold curative/palliative treatment from an elderly GI cancer patient, and cofactors regarding their functional, social, and mental status have to be considered. For this purpose, several tools exist that may be utilized, such as geriatric assessment scores, comorbidity indices, frailty indices, scores for predicting toxicity from chemotherapy, and prognostic indices for survival.
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Affiliation(s)
- Silvana Leo
- Geriatric Oncology Unit-Medical Oncology Department, Vito Fazzi Hospital, Lecce, Italy.
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31
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Naeim A, Ward PR, Wang HJ, Dichmann R, Liem AKD, Chan D, Patel R, Hu EHL, Tchekmedyian NS, Wainberg ZA, Hecht JR. A phase II trial of frontline capecitabine and bevacizumab in poor performance status and/or elderly patients with metastatic colorectal cancer. J Geriatr Oncol 2013; 4:302-9. [PMID: 24472472 DOI: 10.1016/j.jgo.2013.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 05/02/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This study aims to determine the efficacy and tolerability of capecitabine (CAP) plus bevacizumab (BEV) as treatment for frontline metastatic colorectal cancer (mCRC) in frail and/or elderly patients. MATERIALS AND METHODS This was an open label, multi-site, single arm, phase II study in frontline mCRC. In this study, patients (pts) who were frail (ECOG 2) or older patients with ECOG 1 performance status (PS) received CAP (1000 mg/m(2) bid, 14 days of every 21 days) plus BEV (7.5mg/kg iv once every 21 days). The primary objective was progression free survival (PFS). Secondary objectives were overall response rate (ORR) and toxicity. RESULTS In terms of patients: 50 were enrolled; 5 withdrew consent prior to treatment; 45 were treated, and 41 were evaluable. The mean age was 75.9 (range 54-93) and 62% had an ECOG 2 PS. The median PFS was 6.87 months (95% CI, 5.1-11.5 months) and median overall survival was 12.7 months (95% CI, 6.9-12.7 months). The most common grades 3-4 toxicities were: diarrhea (17.8%), fatigue (13.3%), hand-foot syndrome (13.3%), dehydration (8.9%), hypertension (6.7%) and vomiting (6.7%). CONCLUSIONS The results of this trial support the use of CAP plus BEV as first-line treatment for frail/elderly patients with metastatic CRC. The ORR (40%) is comparable to pooled data in elderly on fluorouracil (5-FU)+BEV. The median PFS (7.2 months) in this study is slightly lower than that seen with 5-FU+BEV but this study had a high percentage of ECOG PS 2 patients. Side effects were manageable with no new safety signals.
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Affiliation(s)
- Arash Naeim
- David Geffen School of Medicine at University of California at Los Angeles, 10945 LeConte, Suite 2333 PVUB, Los Angeles, CA 90095, USA.
| | - Peter R Ward
- David Geffen School of Medicine at University of California at Los Angeles, 10945 LeConte, Suite 2333 PVUB, Los Angeles, CA 90095, USA
| | - Hei-Jing Wang
- David Geffen School of Medicine at University of California at Los Angeles, 10945 LeConte, Suite 2333 PVUB, Los Angeles, CA 90095, USA
| | - Richard Dichmann
- Translational Oncology Research International (TORI), Central Coast Medical Oncology, 220 S Palisade Dr Suite 204, Santa Maria, CA 93454, USA
| | - Andre K D Liem
- TORI, Pacific Shores Medical Group, 1043 Elm Avenue, Suite #104, Long Beach, CA 90813, USA
| | - David Chan
- TORI, Cancer Care Associates Medical Group, Inc., 514 North Prospect Ave., 4th Floor, Redondo Beach, CA 90277, USA
| | - Ravi Patel
- Pacific Care, Heritage Physician Network, 5925 Truxtun Extension Ste. A Bakersfield, CA 93309, USA
| | - Edward H L Hu
- Central Hematology Oncology, 707 S. Garfield Ave, Alhambra, CA 91801, USA
| | - Neres S Tchekmedyian
- Pacific Shores Med. Group, Long Beach Elm Office, 1043 Elm Avenue, Suite 104, Long Beach, CA 90813, USA
| | - Zev A Wainberg
- David Geffen School of Medicine at University of California at Los Angeles, 10945 LeConte, Suite 2333 PVUB, Los Angeles, CA 90095, USA
| | - J Randolph Hecht
- David Geffen School of Medicine at University of California at Los Angeles, 10945 LeConte, Suite 2333 PVUB, Los Angeles, CA 90095, USA
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Treatment Strategy for Elderly Patients with Metastatic Colorectal Cancer: A Review of the Systemic Chemotherapy Options. CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-013-0172-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Aprile G, Fontanella C, Lutrino ES, Ferrari L, Casagrande M, Cardellino GG, Rosati G, Fasola G. Angiogenic inhibitors for older patients with advanced colorectal cancer: Does the age hold the stage? World J Gastroenterol 2013; 19:2131-40. [PMID: 23847406 PMCID: PMC3706712 DOI: 10.3748/wjg.v19.i14.2131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 04/12/2013] [Accepted: 04/13/2013] [Indexed: 02/06/2023] Open
Abstract
Although major progress has been achieved in the treatment of advanced colorectal cancer (CRC) with the employment of antiangiogenic agents, several questions remain on the use of these drugs in older patients. Since cardiovascular, renal and other comorbidities are common in the elderly, an accurate assessment of the patients’ conditions should be performed before a treatment decision is made. Since most CRC patients enrolled in clinical trials testing antiangiogenic drugs were aged < 65 years, the efficacy and tolerability of these agents in elderly patients has not been adequately explored. Data suggest that patients with advanced CRC derive similar benefit from bevacizumab treatment regardless of age, but the advantage of other antiangiogenic drugs in the same class of patients appears more blurred. Literature data suggest that specific antiangiogenic-related toxicities such as hypertension or arterial thromboembolic events may be higher in the elderly than in the younger patients. In addition, it should be emphasized that the patients included in the clinical studies discussed herein were selected and therefore may not be representative of the usual elderly population. Advanced age alone should not discourage the use of bevacizumab. However, a careful patients’ selection and watchful monitoring of toxicities are required to optimize the use of antiangiogenics in this population.
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Aprile G, Ferrari L, Fontanella C, Puglisi F. Bevacizumab in older patients with advanced colorectal or breast cancer. Crit Rev Oncol Hematol 2012; 87:41-54. [PMID: 23265855 DOI: 10.1016/j.critrevonc.2012.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/28/2012] [Accepted: 11/20/2012] [Indexed: 12/18/2022] Open
Abstract
The incidence of colorectal and breast cancer is growing among the 550 million living people aged 65 or older. Bevacizumab was the first anti-angiogenic agent approved for the treatment of the advanced phase of these cancers. Although older chronological age still hampers the use of modern treatments, there is a widespread awareness that chronological and physiological (i.e. functional) ages may largely differ, and that seniority itself should not be a stringent limit for the introduction of anti-angiogenics. However, the use of bevacizumab in the general older population is questionable. There is limited evidence of a favorable risk-to-benefit ratio, with efficacy data deriving from clinical trials that selected only elderly patients in rather good health. While summarizing the recent advances, this review highlights specific clinical features characterizing those older patients who may benefit the most from receiving bevacizumab.
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Abstract
Colorectal cancer (CRC) largely affects older individuals; almost half of cases occur in patients >75 years old. The incidence increases with advancing age, doubling every 7 years in patients aged ≥50 years. The medical and societal burdens of CRC will probably worsen over the coming decades as the number of older individuals (>70) continues to grow. No evidence-based guidelines are available for this age group, as older patients with CRC are generally excluded from randomized clinical trials and the fit ones who are recruited are not representative of the general elderly population. When feasible, surgery is the most successful treatment option for eradicating the primary lesion, as well as any metastases. The operative risk under elective conditions is not markedly different in older than in younger patients; however, the acute setting is to be avoided as it is associated with high operative death rates. Well-selected older patients can tolerate chemotherapy, but benefits need to be balanced against potentially limited life expectancy and reduced quality of life. The use of combination chemotherapy is an area of much controversy, but this treatment should not necessarily be withheld because of the age of the patient. Careful monitoring of toxicities and early intervention is essential in older patients undergoing chemotherapy.
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Affiliation(s)
- Riccardo A Audisio
- University of Liverpool, St Helens Teaching Hospital, Department of Surgery, Marshalls Cross Road, St Helens, Liverpool WA9 3DA, UK.
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Rosati G, Avallone A, Aprile G, Butera A, Reggiardo G, Bilancia D. XELOX and bevacizumab followed by single-agent bevacizumab as maintenance therapy as first-line treatment in elderly patients with advanced colorectal cancer: the boxe study. Cancer Chemother Pharmacol 2012; 71:257-64. [PMID: 23100174 DOI: 10.1007/s00280-012-2004-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 10/10/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE The addition of bevacizumab to oxaliplatin-based chemotherapy significantly improved progression-free survival (PFS) in patients with metastatic colorectal cancer (CRC). An increased risk of arterial thromboembolic events has been observed in some trials in older patients, and the potential benefit of a maintenance therapy with bevacizumab alone has not been clearly demonstrated. This phase II study was designed to evaluate the efficacy and safety of XELOX (capecitabine plus oxaliplatin) plus bevacizumab followed by bevacizumab alone in elderly patients with advanced CRC. METHODS Treatment consisted of bevacizumab 7.5 mg/kg and oxaliplatin 130 mg/m(2) on day 1, plus capecitabine 1,000 mg/m(2) twice daily on days 1-14, every 3 weeks up to a maximum of 8 cycles. Patients then received maintenance therapy consisting of bevacizumab alone (7.5 mg/kg) once every 3 weeks up to disease progression. The primary study end-points were safety and response rate. RESULTS A total of 44 patients were recruited. In an intention-to-treat analysis, the overall response rate was 52% [95% confidence interval (CI) 37 to 68%], with 86% of patients achieving disease control. Median PFS and overall survival were 11.5 months (95% CI 10.0-12.9 months) and 19.3 months (95% CI 16.5-22.1 months), respectively. In all, 10 patients (23%) had grade 3/4 adverse events (AEs), the most common being diarrhea (9%), neutropenia (7%), peripheral neuropathy (7%), and stomatitis (7%). No patients died because of treatment-related AEs. The rate of bevacizumab-related AEs (hypertension, thromboembolic events, and gastrointestinal perforation) was consistent with that reported earlier in the general CRC population. CONCLUSION The combination of XELOX and bevacizumab is effective and has a manageable tolerability profile when administered to elderly patients with advanced CRC. Maintenance therapy with single-agent bevacizumab may be considered to extend PFS in this setting of patients.
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Affiliation(s)
- Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy.
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Tilson L, Sharp L, Usher C, Walsh C, S W, O'Ceilleachair A, Stuart C, Mehigan B, John Kennedy M, Tappenden P, Chilcott J, Staines A, Comber H, Barry M. Cost of care for colorectal cancer in Ireland: a health care payer perspective. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2012; 13:511-524. [PMID: 21638069 DOI: 10.1007/s10198-011-0325-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 05/17/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Management options for colorectal cancer have expanded in recent years. We estimated average lifetime cost of care for colorectal cancer in Ireland in 2008, from the health care payer perspective. METHOD A decision tree model was developed in Microsoft EXCEL. Site and stage-specific treatment pathways were constructed from guidelines and validated by expert clinical opinion. Health care resource use associated with diagnosis, treatment and follow-up were obtained from the National Cancer Registry Ireland (n=1,498 cancers diagnosed during 2004-2005) and three local hospital databases (n=155, 142 and 46 cases diagnosed in 2007). Unit costs for hospitalisation, procedures, laboratory tests and radiotherapy were derived from DRG costs, hospital finance departments, clinical opinion and literature review. Chemotherapy costs were estimated from local hospital protocols, pharmacy departments and clinical opinion. Uncertainty was explored using one-way and probabilistic sensitivity analysis. RESULTS In 2008, the average (stage weighted) lifetime cost of managing a case of colorectal cancer was €39,607. Average costs were 16% higher for rectal (€43,502) than colon cancer (€37,417). Stage I disease was the least costly (€23,688) and stage III most costly (€48,835). Diagnostic work-up and follow-up investigations accounted for 4 and 5% of total costs, respectively. Cost estimates were most sensitive to recurrence rates and prescribing of biological agents. CONCLUSION This study demonstrates the value of using existing data from national and local databases in contributing to estimating the cost of managing cancer. The findings illustrate the impact of biological agents on costs of cancer care and the potential of strategies promoting earlier diagnosis to reduce health care resource utilisation and care costs.
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Affiliation(s)
- L Tilson
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin 8, Ireland.
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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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Jensen SA, Sørensen JB. 5-fluorouracil-based therapy induces endovascular injury having potential significance to development of clinically overt cardiotoxicity. Cancer Chemother Pharmacol 2011; 69:57-64. [PMID: 21603868 DOI: 10.1007/s00280-011-1669-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 05/03/2011] [Indexed: 01/26/2023]
Abstract
AIM This study aimed to elucidate the influence of 5-fluorouracil (5-FU)-based therapy on the vascular endothelium and its association with 5-FU-induced heart ischemia. METHODS The study prospectively accrued patients (n = 106) having completely resected colorectal cancer and receiving adjuvant treatment with 5-FU, folinic acid, and oxaliplatin. The levels of plasma von Willebrand factor (vWf), urine albumin-to-creatinine ratio (UACR), coagulation factor II + VII + X, and fibrin D-dimer were serially assessed before, during, and after chemotherapy. RESULTS The vWf level increased from median (range) 1.43 kU/l (0.48 to >3) to 2.64 kU/l (0.23 to >3) (P = 0.001), the UACR increased from 1.1 ± 0.2 mg/mmol (mean ± SE) to 2.1 ± 0.3 mg/mmol (P = 0.001), the coagulation factor II + VII + X activity decreased from 1.00 ± 0.02 to 0.94 ± 0.02 U/l (P = 0.001), and the fibrin D-dimer level increased from 1.1 ± 0.2 to 2.1 ± 0.3 kU/l (P = 0.001) at baseline and during chemotherapy, respectively. The changes in the levels of vWf (P = 0.3), UACR (P = 0.8), coagulation factor II + VII + X (P = 0.8), and fibrin D-dimer (P = 0.6) in nine (8.5%) patients having clinical signs of cardiotoxicity were not significantly different from that of the patients not having cardiotoxicity. The 5-FU-induced rise in plasma biomarkers was not significantly related to the cardiovascular morbidity or its risk factors (P = 0.9). CONCLUSIONS 5-FU therapy induces global reversible endothelial injury leading to a procoagulant state. The ensuing endothelial dysfunction may be of significance to the pathogenesis of 5-FU-induced clinically overt cardiotoxicity. Cardiovascular disease is not significant for the vulnerability of the endothelium to 5-FU-based chemotherapy.
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Affiliation(s)
- Søren Astrup Jensen
- Department of Oncology 5073, Rigshospitalet, Copenhagen University Hospital, 9 Blegdamsvej, 2100 Copenhagen, Denmark.
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Hirsch BR, Zafar SY. Capecitabine in the management of colorectal cancer. Cancer Manag Res 2011; 3:79-89. [PMID: 21629830 PMCID: PMC3097797 DOI: 10.2147/cmr.s11250] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Indexed: 12/27/2022] Open
Abstract
5-Fluorouracil has been a mainstay in the treatment of colorectal cancer for nearly five decades; however, the use of oral formulations of the medication has been gaining increasing traction since capecitabine was approved for use in adjuvant settings by the US Food and Drug Administration in 2005. The use of capecitabine has since spread to a number of off-label indications, including the treatment of advanced or metastatic colorectal cancer and the neoadjuvant treatment of rectal cancer. In light of increasing utilization, it is critical that clinicians have a firm understanding of the literature supporting capecitabine across various settings as well as the attributes of the drug, such as its dosing recommendations, side-effect profile, and use in the elderly. The purpose of this review is to synthesize the literature in a fashion that can be used to help guide decisions. In a setting of increasing focus on cost, the pharmacoeconomic literature is also briefly reviewed.
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Affiliation(s)
- Bradford R Hirsch
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
| | - S Yousuf Zafar
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
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Kawasaki A, Mimatsu K, Oida T, Kanou H, Kuboi Y, Fukino N, Kida K, Amano S. A case of long partial response to combination therapy of bevacizumab and capecitabine for liver metastases of rectal cancer. Case Rep Gastroenterol 2011; 5:28-32. [PMID: 21326855 PMCID: PMC3037991 DOI: 10.1159/000323138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 69-year-old female visited our department with a diagnosis of rectosigmoid cancer and multiple hepatic metastases (stage IV). Abdominal CT revealed multiple metastatic lesions in the bilateral lobes of the liver. The primary lesion was considered to be resectable, and high anterior resection of the rectum was performed. After the operation, 6 courses of therapy with bevacizumab (BV) and modified FOLFOX6 were performed. CT showed a partial response, and tumor marker levels became normal. After a total of 11 courses of this therapy, grade 3 peripheral neuropathy developed, and the therapy was changed to BV and capecitabine (Cape). After 6 courses of this therapy, CT showed the maintenance of partial response, and tumor marker levels were also within the normal range. BV and Cape therapy may be useful not only for reducing peripheral neuropathy, but also as a maintenance therapy in patients requiring the suspension of oxaliplatin administration due to peripheral neuropathy.
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Affiliation(s)
- Atsushi Kawasaki
- Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Japan
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Molina-Garrido MJ, Guillén-Ponce C. Comment on 'capecitabine and bevacizumab as first-line treatment in elderly patients with metastatic colorectal cancer'. Br J Cancer 2011; 104:224-5; author reply 226. [PMID: 21157451 PMCID: PMC3039811 DOI: 10.1038/sj.bjc.6606037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- M J Molina-Garrido
- Medical Oncology Section in the Hospital Virgen de la Luz in Cuenca, Hermandad Donantes de Sangre Street, Cuenca, CP: 16002, Spain
| | - C Guillén-Ponce
- Medical Oncology Service in the Hospital Ramón y Cajal in Madrid, Madrid, Spain
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François E, Guérin O, Follana P, Evesque L, Mari V, Aparicio T. Use of bevacizumab in elderly patients with metastatic colorectal cancer: Review. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2010.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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