1
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Gallois C, Shi Q, Pederson LD, André T, Iveson TJ, Sobrero AF, Alberts S, de Gramont A, Meyerhardt JA, George T, Schmoll HJE, Souglakos I, Harkin A, Labianca R, Sinicrope FA, Oki E, Shields AF, Boukovinas I, Kerr R, Lonardi S, Yothers G, Yoshino T, Goldberg RM, Taieb J, Papamichael D. Oxaliplatin-Based Adjuvant Chemotherapy in Older Patients With Stage III Colon Cancer: An ACCENT/IDEA Pooled Analysis of 12 Trials. J Clin Oncol 2024; 42:2295-2305. [PMID: 38547438 DOI: 10.1200/jco.23.01326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/30/2023] [Accepted: 02/28/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE A number of studies suggest that older patients may have reduced or no benefit from the addition of oxaliplatin to fluoropyrimidines as adjuvant chemotherapy for stage III colon cancer (CC). MATERIALS AND METHODS We studied the prognostic impact of age, as well as treatment adherence/toxicity patterns according to age, in patients with stage III CC who received 3 or 6 months of infusional fluorouracil, leucovorin, and oxaliplatin/capecitabine and oxaliplatin (CAPOX) on the basis of data collected from trials from the ACCENT and IDEA databases. Associations between age and time to recurrence (TTR), disease-free survival (DFS), overall survival (OS), survival after recurrence (SAR), and cancer-specific survival (CSS) were assessed by a Cox model or a competing risk model, stratified by studies and adjusted for sex, performance status, T and N stage, and year of enrollment. RESULTS A total of 17,909 patients were included; 24% of patients were age older than 70 years (n = 4,340). Patients age ≥70 years had higher rates of early treatment discontinuation. Rates of grade ≥3 adverse events were similar between those older and younger than 70 years, except for diarrhea and neutropenia that were more frequent in older patients treated with CAPOX (14.2% v 11.2%; P = .01 and 12.1% v 9.6%; P = .04, respectively). In multivariable analysis, TTR was not significantly different between patients <70 years and those ≥70 years, but DFS, OS, SAR, and CSS were significantly shorter in those patients ≥70 years. CONCLUSION In patients ≥70 years with stage III CC fit enough to be enrolled in clinical trials, oxaliplatin-based adjuvant chemotherapy was well tolerated and led to similar TTR compared with younger patients, suggesting similar efficacy. TTR may be a more appropriate end point for efficacy in this patient population.
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Affiliation(s)
- Claire Gallois
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, SIRIC CARPEM, Paris-Cité University, Paris, France
| | - Qian Shi
- Department of Quantitative Health Science, Mayo Clinic, Rochester, MN
| | - Levi D Pederson
- Department of Quantitative Health Science, Mayo Clinic, Rochester, MN
| | - Thierry André
- Department of Medical Oncology, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Timothy J Iveson
- Department of Medical Oncology, University of Southampton, Southampton, United Kingdom
| | | | | | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Thomas George
- University of Florida Health Cancer Center, Gainesville, FL
| | - Hans-Joachim E Schmoll
- Department Internal Medicine, Clinic of Internal Medicine IV, University Clinic Halle, Martin-Luther University, Halle, Germany
| | - Ioannis Souglakos
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece
| | - Andrea Harkin
- Cancer Research UK Glasgow Clinical Trials Unit, Glasgow, United Kingdom
| | - Roberto Labianca
- Cancer Center, Ospedale Papa Giovanni XXIII Bergamo, Bergamo, Italy
| | | | - Eiji Oki
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | | | | | - Rachel Kerr
- Department of Oncology, Oxford University, Oxford, United Kingdom
| | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Richard M Goldberg
- West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center, Morgantown, WV
| | - Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, SIRIC CARPEM, Paris-Cité University, Paris, France
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2
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Akagündüz B, Guven DC, Ozer M, Okten IN, Atag E, Unek İT, Tatli AM, Karaoglu A. Tailoring adjuvant chemotherapy by circulating tumor DNA (ctDNA) in older patients with stage II-III colon cancer. J Geriatr Oncol 2023; 14:101367. [PMID: 36038467 DOI: 10.1016/j.jgo.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Baran Akagündüz
- Department of Medical Oncology, Erzincan Binali Yıldrıım University Medical School, Erzincan, Turkey.
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Medical School, Istanbul, Turkey
| | - Muhammet Ozer
- Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA.
| | - Ilker Nihat Okten
- Department of Medical Oncology, Gaziantep Ersin Arslan State Hospital, Gaziantep, Turkey
| | - Elif Atag
- Department of Medical Oncology, Haydarpaşa Numune Research Hospital, Istanbul, Turkey
| | - İlkay Tugba Unek
- Department of Medical Oncology, Dokuzeylül University Medical School, 34000 Istanbul, Turkey
| | - Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University Medical School, 07010 Antalya, Turkey
| | - Aziz Karaoglu
- Department of Medical Oncology, Dokuzeylül University Medical School, 34000 Istanbul, Turkey
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3
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Shiraishi T, Ogawa H, Shioi I, Ozawa N, Osone K, Okada T, Sohda M, Shirabe K, Saeki H. Differences in prognosis and underuse of adjuvant chemotherapy between elderly and non-elderly patients in stage III colorectal cancer. Ann Gastroenterol Surg 2023; 7:91-101. [PMID: 36643370 PMCID: PMC9831896 DOI: 10.1002/ags3.12604] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023] Open
Abstract
Aim We aimed to clarify the use of adjuvant chemotherapy and the prognosis of elderly colorectal cancer patients compared with non-elderly patients, and the usefulness of sarcopenia as an indicator for the introduction and completion of adjuvant chemotherapy. Methods Between 2013 and 2021, 215 patients with pStage III disease were included. We investigated perioperative clinicopathological factors, adjuvant chemotherapy details, and prognosis. Preoperative sarcopenia status was evaluated using computed tomography images. Elderly patients were defined as those aged ≥70 years. Results We included 121 (56.3%) and 94 (43.7%) non-elderly and elderly patients, respectively. Among the elderly patients, 47 had sarcopenia. There were no significant differences in the incompletion rate of adjuvant chemotherapy between elderly and non-elderly patients (27.1%/16.2%, P = 0.119). The most common reason for the discontinuation of adjuvant chemotherapy was side effects, regardless of age. The respective 3-year-disease free survival of patients with no/completed/incomplete adjuvant chemotherapy were 65.5%, 80.2%, and 57.7% for non-elderly patients (P = 0.045) and 73.4%, 70.6%, and 71.6% for elderly patients (P = 0.924). The number of elderly patients with sarcopenia was significantly higher in patients without adjuvant chemotherapy (P = 0.004) and those with incomplete adjuvant chemotherapy (P = 0.004). The 3-year-disease free survival of elderly sarcopenic patients without and with adjuvant chemotherapy were 78.3% and 59.2%, respectively (P = 0.833). Conclusion Elderly patients did not show a benefit of adjuvant chemotherapy regardless of whether they had completed adjuvant chemotherapy, unlike non-elderly patients. Moreover, the evaluation of preoperative sarcopenia in elderly colorectal cancer patients may be useful in determining the indication for adjuvant chemotherapy.
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Affiliation(s)
- Takuya Shiraishi
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Hiroomi Ogawa
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Ikuma Shioi
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Naoya Ozawa
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Katsuya Osone
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Takuhisa Okada
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Makoto Sohda
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Ken Shirabe
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Hiroshi Saeki
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
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4
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Tsuchiya A, Ogawa C, Kondo N, Kojima Y, Yamada Y, Terakado H. Exploratory study on relative dose intensity and reasons for dose reduction of adjuvant CAPOX therapy in elderly patients with colorectal cancer. Glob Health Med 2022; 4:180-185. [PMID: 35855064 PMCID: PMC9243406 DOI: 10.35772/ghm.2021.01018] [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: 02/12/2021] [Revised: 12/03/2021] [Accepted: 12/22/2021] [Indexed: 06/15/2023]
Abstract
Capecitabine plus oxaliplatin, CAPOX, therapy is one of the standardized options for adjuvant chemotherapy for colorectal cancer, but the efficacy and the safety of CAPOX in elderly patients are unclear. In this study, we investigated the relative dose intensity (RDI) and reasons for dose reduction in patients over the age of 70 (elderly group) (n = 12) and those under the age of 70 (non-elderly group) (n = 24) receiving adjuvant CAPOX therapy for colorectal cancer. The median RDIs were 71.1% in the elderly group and 67.9% in the non-elderly group for oxaliplatin (p = 0.416), and 81.6% and 86.4% for capecitabine (p = 0.166), respectively. The rate of peripheral neuropathy which was the reason for dose reduction of oxaliplatin was approximately 4.5-fold higher in the non-elderly group than in the elderly group. In addition, hematologic toxicity was the most common reason for dose reduction at 50.0% in the elderly group. The results of this study suggested that a similar therapeutic intensity can be maintained in elderly patients relative to non-elderly patients by appropriate dose reduction and discontinuation of drug treatments. Elderly patients are more susceptible to hematologic toxicity than to peripheral neuropathy.
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Affiliation(s)
- Ayumi Tsuchiya
- Pharmaceutical Department, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Chiaki Ogawa
- Pharmaceutical Department, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Naoki Kondo
- Pharmaceutical Department, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasushi Kojima
- Gastroenterology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuhide Yamada
- Comprehensive Cancer Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Terakado
- Pharmaceutical Department, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
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5
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Hamed RA, Korpanty G, Kelly D. Toxicities and outcomes of neoadjuvant treatment in elderly patients with locally advanced rectal cancer: a scoping review protocol. BMJ Open 2022; 12:e061397. [PMID: 35501084 PMCID: PMC9062800 DOI: 10.1136/bmjopen-2022-061397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Colorectal cancer remains the second leading cause of cancer-related death in 60-79 years old and the third leading cause of death in patients aged 80 and above. Rectal cancer accounts for approximately a third of colorectal cancer diagnoses. The current standard of care for managing locally advanced rectal cancer involves a multimodal combined approach with neoadjuvant treatment, surgery with total mesorectal excision and adjuvant chemotherapy. Neoadjuvant treatment can be in the form of short-course radiotherapy, long-course concurrent radiotherapy with chemotherapy or total neoadjuvant chemotherapy with concurrent chemoradiotherapy followed by chemotherapy. This scoping aims to assess the toxicity and outcome of the different neoadjuvant treatment modalities in elderly patients. METHODS AND ANALYSIS We will use Arksey and O'Malley's five scoping review methodology framework stages. Searches will be conducted in Ovid Medline, Embase, Cochrane database and CINAHL. In addition, the researcher will hand search for all registered trials, using a combination of terms such as "locally advanced rectal cancer", "neoadjuvant treatment", and "elderly patients." Two independent reviewers will screen titles and abstracts and then full text based on predefined inclusion and exclusion criteria. Publications will be extracted using a customised data extraction tool to include study characteristics, research topics, exposures and outcomes. ETHICS AND DISSEMINATION Ethics approval is not required as the data will be collected from the existing literature. The findings of this study will help with future clinical research on the topic. We will publish the findings of this review in a peer-reviewed journal and present them at academic conferences targeting geriatric oncology service providers.
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Affiliation(s)
- Ruba Ahmed Hamed
- School Of Medicine, University of Limerick, Limerick, Ireland
- Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Greg Korpanty
- Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Dervla Kelly
- School Of Medicine, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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6
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Cross AJ, Kornfält P, Lidin J, Buchwald P, Frizelle FA, Eglinton TW. Surgical outcomes following colorectal cancer resections in patients aged 80 years and over: results from the Australia and New Zealand Binational Colorectal Cancer Audit. Colorectal Dis 2021; 23:814-822. [PMID: 33188657 DOI: 10.1111/codi.15445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 02/08/2023]
Abstract
AIM The primary aim was to compare the 30-day morbidity and mortality in patients aged ≥80 years undergoing surgery for colorectal cancer with those aged <80 years. The secondary aim was to identify independent outcome predictors. METHOD This was a retrospective study of patients undergoing surgery for colorectal cancer between January 2007 and February 2018. Patients were divided into those <80 years and those ≥80 years at the time of surgery. Data had been collected prospectively by the Australasian Binational Colorectal Cancer Audit and included patient demographics, site and stage of tumour, comorbidity, operative details, American Society of Anesthesiologists score (ASA), pathological staging, 30-day mortality and morbidity (medical and surgical). Univariate and multivariate analyses were used to identify predictors of 30-day morbidity and mortality. RESULTS During the study period, 4600 out of 20 463 (22.5%) patients were ≥80 years. They had a greater 30-day mortality after both colonic (97/2975 [3.3%] vs. 66/7010 [0.9%], P < 0.001) and rectal resections (50/1625 [3.1%] vs. 36/9006 [0.4%], P < 0.001) compared with younger patients. They also had an increased length of stay (colon cancer, 9 vs. 7 days; rectal cancer, 10 vs. 8 days; P < 0.001) and medical complications (colon cancer, 23.5% vs. 12.7%; rectal cancer, 25.2% vs. 11.2%; P < 0.001). Surgical complications were equivalent. Age ≥80 years was not an independent predictor of 30-day morbidity or mortality. Patients ≥80 years who were ASA 2/3 and had rectal cancer seemed to fare worse in terms of 30-day mortality (ASA 2, 22%, 95% CI 9%-36%, P < 0.001; ASA 3, 11%, 95% CI 4%-19%, P< 0.001). CONCLUSIONS Postoperative morbidity and mortality are significantly greater in patients ≥80 years undergoing colorectal cancer surgery. Any recommendation for surgery in this age group should take into account patient comorbidity and not be based on age alone.
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Affiliation(s)
- Andrea J Cross
- Departments of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago Christchurch, Christchurch, New Zealand
| | | | | | - Pamela Buchwald
- Lund University, Lund, Sweden.,Skåne University Hospital, Malmö, Sweden
| | - Frank A Frizelle
- Departments of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago Christchurch, Christchurch, New Zealand
| | - Timothy W Eglinton
- Departments of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago Christchurch, Christchurch, New Zealand
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7
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Hoshino N, Aoyama R, Hida K. Survival benefit of adjuvant chemotherapy in elderly patients with colon cancer: a systematic review and meta-analysis. Int J Clin Oncol 2021; 26:883-892. [PMID: 33423148 DOI: 10.1007/s10147-021-01858-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Adjuvant chemotherapy after curative resection is established as a standard therapy for colon and rectal cancer. Although the efficacy of adjuvant chemotherapy has been shown by pooled analyses from randomized controlled trials, elderly patients still receive adjuvant chemotherapy less frequently than younger patients. In this systematic review and meta-analysis, we aimed to assess the survival benefit of adjuvant chemotherapy in elderly patients based on observational studies in which the elderly patients would likely be representative of those encountered in real-world clinical settings. METHODS A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Observational studies that investigated the survival benefit of adjuvant chemotherapy after curative resection in elderly patients (age ≥ 70 years) with colon or rectal cancer were included. The 5-year overall survival (OS) rate and OS were assessed. Risk of bias was assessed using the ROBINS-I tool. RESULTS Eleven studies in elderly patients with colon cancer were included. No relevant study was identified for rectal cancer. Elderly patients who received adjuvant chemotherapy had a significantly higher 5-year OS rate than those who did not (risk ratio 1.51, 95% confidence interval 1.29-1.76, P < 0.001). There was also a significant improvement in OS in elderly patients who received adjuvant chemotherapy (hazard ratio 0.59, 95% confidence interval 0.53-0.66, P < 0.001). The overall risk of bias was judged to be critical for both outcomes. CONCLUSION Adjuvant chemotherapy provides a survival benefit for elderly patients with colon cancer, although the quality of evidence is low.
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Affiliation(s)
- Nobuaki Hoshino
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Ryuhei Aoyama
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koya Hida
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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8
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Bojesen RD, Friis M, Gögenur I. Age is an individual risk factor for not being referred to adjuvant chemotherapy in patients resected for UICC III colorectal cancer: a nationwide cohort study. Acta Oncol 2020; 59:1538-1542. [PMID: 32752903 DOI: 10.1080/0284186x.2020.1795251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rasmus Dahlin Bojesen
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital, Køge, Denmark
| | - Marie Friis
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital, Køge, Denmark
- Department of Geriatric Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital, Køge, Denmark
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9
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Méndez Méndez JC, Salgado Fernández M, de la Cámara Gómez J, Pellón Augusto ML, Covela Rua M, Quintero Aldana G, Fernández Montes A, Reboredo López M, Valladares Ayerbes M, Jorge Fernández M, González Villarroel P, Romero Reinoso C, Ramos Vázquez M. First-line panitumumab plus capecitabine for the treatment of older patients with wild-type RAS metastatic colorectal cancer. The phase II, PANEL study. J Geriatr Oncol 2020; 11:1263-1267. [DOI: 10.1016/j.jgo.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/24/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
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10
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Simillis C, Singh HKSI, Afxentiou T, Mills S, Warren OJ, Smith JJ, Riddle P, Adamina M, Cunningham D, Tekkis PP. Postoperative chemotherapy improves survival in patients with resected high-risk Stage II colorectal cancer: results of a systematic review and meta-analysis. Colorectal Dis 2020; 22:1231-1244. [PMID: 31999888 DOI: 10.1111/codi.14994] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to assess the benefit of adjuvant chemotherapy in high-risk Stage II colorectal cancer. METHOD A systematic literature review and meta-analysis was performed comparing survival in patients with resected Stage II colorectal cancer and high-risk features having postoperative chemotherapy vs no chemotherapy. RESULTS Of 1031 articles screened, 29 were included, reporting on 183 749 participants. Adjuvant chemotherapy significantly improved overall survival [hazard ratio (HR) 0.61, P < 0.0001], disease-specific survival (HR = 0.73, P = 0.05) and disease-free survival (HR = 0.59, P < 0.0001) compared to no chemotherapy. Adjuvant chemotherapy significantly increased 5-year overall survival (OR = 0.53, P = 0.0008) and 5-year disease-free survival (OR = 0.50, P = 0.001). Overall survival and disease-free survival remained significantly prolonged during subgroup analysis of studies published from 2015 onwards (HR = 0.60, P < 0.0001; HR = 0.65, P = 0.0001; respectively), in patients with two or more high-risk features (HR = 0.59, P = 0.0001; HR = 0.70, P = 0.03; respectively) and in colon cancer (HR = 0.61, P < 0.0001; HR = 0.51, P = 0.0001; respectively). Overall survival, disease-specific survival and disease-free survival during subgroup analysis of individual high-risk features were T4 tumour (HR = 0.58, P < 0.0001; HR = 0.50, P = 0.003; HR = 0.75, P = 0.05), < 12 lymph nodes harvested (HR = 0.67, P = 0.0002; HR = 0.80, P = 0.17; HR = 0.72, P = 0.02), poor differentiation (HR = 0.84, P = 0.35; HR = 0.85, P = 0.23; HR = 0.61, P = 0.41), lymphovascular or perineural invasion (HR = 0.55, P = 0.05; HR = 0.59, P = 0.11; HR = 0.76, P = 0.05) and emergency surgery (HR = 0.60, P = 0.02; HR = 0.68, P = 0.19). CONCLUSION Adjuvant chemotherapy in high-risk Stage II colorectal cancer results in a modest survival improvement and should be considered on an individual patient basis. Due to potential heterogeneity and selection bias of the included studies, and lack of separate rectal cancer data, further large randomized trials with predefined inclusion criteria and standardized chemotherapy regimens are required.
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Affiliation(s)
- C Simillis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - H K S I Singh
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - T Afxentiou
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - S Mills
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - O J Warren
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - J J Smith
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - P Riddle
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - M Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - D Cunningham
- Gastrointestinal Unit, The Royal Marsden Hospital, London, UK
| | - P P Tekkis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK.,Gastrointestinal Unit, The Royal Marsden Hospital, London, UK
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11
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Glimelius B, Osterman E. Adjuvant Chemotherapy in Elderly Colorectal Cancer Patients. Cancers (Basel) 2020; 12:cancers12082289. [PMID: 32823998 PMCID: PMC7464071 DOI: 10.3390/cancers12082289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
The value of adjuvant chemotherapy in elderly patients has been the subject of many overviews, with opinions varying from “not effective”, since randomized trials have not been performed, to “as effective as in young individuals”, based upon many retrospective analyses of randomized trials that have included patients of all ages. In the absence of randomized trials performed specifically with elderly patients, retrospective analyses demonstrate that the influence on the time to tumour recurrence (TTR) may be the same as in young individuals, but that endpoints that include death for any reason, such as recurrence-free survival (RFS), disease-free survival (DFS), and overall survival (OS), are poorer in the elderly. This is particularly true if oxaliplatin has been part of the treatment. The need for adjuvant chemotherapy after colorectal cancer surgery in elderly patients is basically the same as that in younger patients. The reduction in recurrence risks may be similar, provided the chosen treatment is tolerated but survival gains are less. Adding oxaliplatin to a fluoropyrimidine is probably not beneficial in individuals above a biological age of approximately 70 years. If an oxaliplatin combination is administered to elderly patients, three months of therapy is in all probability the most realistic goal.
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Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-75185 Uppsala, Sweden;
- Correspondence: ; Tel.: +46-18-611-24-32
| | - Erik Osterman
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-75185 Uppsala, Sweden;
- Department of Surgery, Gävle Hospital, Region Gävleborg, SE-80187 Gävle, Sweden
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12
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Minicozzi P, Vicentini M, Innos K, Castro C, Guevara M, Stracci F, Carmona-Garcia M, Rodriguez-Barranco M, Vanschoenbeek K, Rapiti E, Katalinic A, Marcos-Gragera R, Van Eycken L, Sánchez MJ, Bielska-Lasota M, Rossi PG, Sant M. Comorbidities, timing of treatments, and chemotherapy use influence outcomes in stage III colon cancer: A population-based European study. Eur J Surg Oncol 2020; 46:1151-1159. [PMID: 32147427 DOI: 10.1016/j.ejso.2020.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/21/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION For stage III colon cancer (CC), surgery followed by chemotherapy is the main curative approach, although optimum times between diagnosis and surgery, and surgery and chemotherapy, have not been established. MATERIALS AND METHODS We analysed a population-based sample of 1912 stage III CC cases diagnosed in eight European countries in 2009-2013 aiming to estimate: (i) odds of receiving postoperative chemotherapy, overall and within eight weeks of surgery; (ii) risks of death/relapse, according to treatment, Charlson Comorbidity Index, time from diagnosis to surgery for emergency and elective cases, and time from surgery to chemotherapy; and (iii) time-trends in chemotherapy use. RESULTS Overall, 97% of cases received surgery and 65% postoperative chemotherapy, with 71% of these receiving chemotherapy within eight weeks of surgery. Risks of death and relapse were higher for cases starting chemotherapy with delay, but better than for cases not given chemotherapy. Fewer patients with high comorbidities received chemotherapy than those with low (P < 0.001). Chemotherapy timing did not vary (P = 0.250) between high and low comorbidity cases. Electively-operated cases with low comorbidities received surgery more promptly than high comorbidity cases. Risks of death and relapse were lower for elective cases given surgery after four weeks than cases given surgery within a week. High comorbidities were always independently associated with poorer outcomes. Chemotherapy use increased over time. CONCLUSIONS Our data indicate that promptly-administered postoperative chemotherapy maximizes its benefit, and that careful assessment of comorbidities is important before treatment. The survival benefit associated with slightly delayed elective surgery deserves further investigation.
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Affiliation(s)
- Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Clara Castro
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal; EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Marcela Guevara
- Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fabrizio Stracci
- Department of Experimental Medicine, Section of Public Health, University of Perugia, Perugia, Italy; Umbria Cancer Registry, Perugia, Italy
| | - MaCarmen Carmona-Garcia
- Medical Oncology Department, Catalan Institute of Oncology, Universitary Hospital Dr Josep Trueta, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Miguel Rodriguez-Barranco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | | | - Elisabetta Rapiti
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Switzerland
| | | | - Rafael Marcos-Gragera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain; School of Medicine, University of Girona (UdG), Girona, Spain; Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | | | - Maria José Sánchez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Universidad de Granada (UGR), Granada, Spain
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Shafiei M, Beale P, Blinman P. Utilisation of Adjuvant Chemotherapy and 5-Year Survival Analysis of Prospectively Recorded Cohort Data for Older Adults Versus Younger Adults with Resected Primary Colon Cancer. J Gastrointest Cancer 2019; 51:988-997. [PMID: 31811472 DOI: 10.1007/s12029-019-00343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Colon cancer is predominantly a disease of older adults. Studies determining the influence of age on outcomes of colon cancer have conflicting results. We aim to determine the long-term outcomes and utilisation of adjuvant chemotherapy of older adults compared with younger adults who had had a resection of a primary colon cancer. METHODS Consecutive patients who had resection of a primary colon cancer between January 1, 2000 and December 31, 2010 were identified from a prospective database and stratified into three age groups: ≤ 69 years, 70 to 79 years, and ≥ 80 years. Age-related differences in patients, cancer, and treatment characteristics were determined by chi-square tests. Five-year overall survival and cancer-specific survival were determined by Kaplan-Meier method and by multivariable Cox regression analysis to adjust for potential confounding factors. RESULTS Of 1135 included patients, 469 (41%) patients were aged ≤ 69 years, 382 (34%) were 70-79 years, and 284 (25%) were ≥ 80 years. Increasing age group predicted more comorbidity (p < 0.001), cardiac comorbidity (p < 0.001), right-sided cancers (p < 0.001), and less adjuvant chemotherapy (stage III only; p < 0.001). Increasing age group was associated with worse overall survival by stage (p < 0.001) but not cancer-specific survival by stage (p = 0.83). Adjuvant chemotherapy in patients with stage III colon cancer independently predicted improved overall survival (p < 0.001) and cancer-specific survival (p = 0.01). CONCLUSIONS Compared with younger adults, older adults with colon cancer had worse survival outcomes and received less adjuvant chemotherapy.
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Affiliation(s)
- Mohsen Shafiei
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia. .,Concord Repatriation General Hospital, Concord, NSW, 2139, Australia. .,Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Road, Concord, NSW, 2139, Australia.
| | - Philip Beale
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - Prunella Blinman
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
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Abdel-Rahman O, Karachiwala H. Impact of age on toxicity and efficacy of 5-FU-based combination chemotherapy among patients with metastatic colorectal cancer; a pooled analysis of five randomized trials. Int J Colorectal Dis 2019; 34:1741-1747. [PMID: 31492988 DOI: 10.1007/s00384-019-03389-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the impact of age on toxicity and efficacy outcomes of metastatic colorectal cancer treated with 5FU-based combination chemotherapy. METHODS Project Data Sphere (PDS) platform has been accessed and de-identified datasets of the following clinical trials were downloaded (NCT00272051; NCT00305188; NCT00115765; NCT00364013; and NCT00384176). Multivariable logistic regression analysis was used to assess the impact of age (< 70 years versus ≥ 70 years) on the probability of different toxicities. Multivariable Cox regression analysis was additionally used to evaluate the impact of age (< 70 years versus ≥ 70 years) on overall and progression-free survival. RESULTS Among a total of 3223 patients included in the current analysis, 2488 patients were < 70 years; while 735 patients were ≥ 75 years at randomization. Older age was associated with a higher probability of serious adverse events (OR (odds ratio) 0.649; 95% CI 0.545-0.772; P < 0.001), fatal adverse events (OR 0.416; 95% CI 0.299-0.579; P < 0.001), all-grade diarrhea (OR 0.834; 95% CI 0.699-0.994, P = 0.043), high-grade diarrhea (OR 0.734; 95% CI 0.577-0.933, P = 0.012), high-grade stomatitis (OR 0.500, 95% CI 0.290-0.861, P = 0.012), high-grade thrombocytopenia (OR 0.578; 95% CI 0.359-0.930, P = 0.024), all-grade neutropenia (OR 0.690; 95% CI 0.578-0.824, P < 0.001), and high-grade neutropenia (OR 0.661; 95% CI 0.549-0.796, P < 0.001). In a multivariable Cox regression analysis for factors affecting overall survival, older age was associated with worse overall survival (hazard ratio for younger age versus older age 0.848; 95% CI 0.754-0.954, P = 0.006). On the hand, older age was not associated with worse progression-free survival (hazard ratio for younger age versus older age 0.933; 95% CI 0.843-1.032, P = 0.179). CONCLUSION Metastatic colorectal cancer patients ≥ 70 years of age who are treated with 5FU-based combination chemotherapy are more likely to have serious adverse events, fatal adverse events as well as worse overall survival compared to younger patients.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T4G1Z2, Canada.
| | - Hatim Karachiwala
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T4G1Z2, Canada
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15
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Adjuvant chemotherapy does not provide survival benefits to elderly patients with stage II colon cancer. Sci Rep 2019; 9:11846. [PMID: 31413354 PMCID: PMC6694195 DOI: 10.1038/s41598-019-48197-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023] Open
Abstract
To date, the effect of adjuvant chemotherapy after curative resection in patients with stage II colon cancer remains controversial. Still, little is known about the effects of adjuvant chemotherapy in patients with stage II colon cancer who are older than 70 years, as most studies did not focus on this population. This study aimed to investigate the oncologic outcomes of elderly patients with stage II colon cancer who underwent curative resection with or without postoperative adjuvant chemotherapy. We retrospectively reviewed medical records of patients older than 70 years who underwent curative resection of stage II primary colon cancer during 2002–2015. Patients were classified into surgery alone (SA) and adjuvant chemotherapy (AC) groups and propensity score-matched at a 1:1 ratio using a logistic regression. The end points were recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS). Of the 623 patients who met the criteria, 145 were assigned to each arm after propensity score matching. The mean ages of the SA and AC groups were 74.3 and 74.0 years, respectively. A log-rank test revealed no significant inter-group differences in RFS (p = 0.202), CSS (p = 0.486) or OS (p = 0.299). In a Cox regression analysis, adjuvant chemotherapy was not found to be an independent factor affecting RFS (p = 0.206), CSS (p = 0.487) or OS (p = 0.301). Adjuvant chemotherapy does not appear to yield survival benefits in elderly patients with stage II colon cancer.
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Abstract
Clinical research in neuro-oncology frequently classifies patients over 60-70 years of age as 'elderly', a designation intended to identify patients with the disease characteristics, psychosocial changes, and susceptibility to treatment toxicities associated with advancing age. The elderly account for a large proportion of patients diagnosed with glioblastoma (GBM), and this population is projected to increase. Their prognosis is inferior to that of GBM patients as a whole, and concerns over treatment toxicity may limit the aggressiveness with which they are treated. Recent clinical studies have assisted with therapeutic decision making in this cohort. Hypofractionated radiation with concurrent and adjuvant temozolomide has been shown to increase survival without worsened quality of life in elderly patients with good functional status. Single modality radiation therapy or temozolomide therapy are frequently used in this population, and while neither has demonstrated superiority, O6-methylguanine-DNA methyltransferase (MGMT) methylation status is predictive of improved survival with temozolomide over radiation therapy. Despite these advances, ambiguity as to how to best define, assess, and treat this population remains. The specific response of elderly patients to emerging therapies, such as immunotherapies, is unclear. Advancing outcomes for elderly patients with GBM requires persistent efforts to include them in translational and clinical research endeavors, and concurrent dedication to the preservation of function and quality of life in this population.
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Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0431, Houston, TX, 77030, USA.
| | - John F de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0431, Houston, TX, 77030, USA
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