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Fernando D, Hanna J, Cohen R, Ryan J. Adjuvant chemotherapy improves survival amongst octogenarians following resection of colorectal adenocarcinoma. ANZ J Surg 2024; 94:181-186. [PMID: 37772450 DOI: 10.1111/ans.18715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The Australian population is ageing, with an increasing number of patients diagnosed with colorectal cancer in their eighth decade. This group represents a challenging cohort to deliver multidisciplinary care, with increased morbidity and mortality related to surgical and oncological therapies. This project aimed to compare surgical and oncological outcomes in octogenarian and non-octogenarian patients with colorectal cancer. METHODS A matched case-control retrospective review of a prospectively maintained institutional database of colorectal cancer patients treated between 2005 and 2021 was conducted. Patient demographics, treatment details, peri-operative complications, and long-term survival were reported. The primary outcome, cancer-specific survival, was investigated using time-to-event analysis and interrogated with multivariate regression. RESULTS There were 747 patients included in the study. There was no difference in five-year cancer-specific survival and recurrence-free survival between cohorts. Multivariate analysis for octogenarians confirmed a significant hazard signal associated with worsening cancer stage and a survival benefit associated with the administration of adjuvant therapy. However, we noted that stage-matched octogenarian patients received less adjuvant treatment compared to non-octogenarians. CONCLUSION Octogenarians undergoing treatment for colorectal cancer have similar cancer-specific survival and recurrence-free survival to non-octogenarians. Our study demonstrates a survival benefit when adjuvant therapy is provided to octogenarians, despite only half of this cohort receiving therapy compared to their younger peers. Further research into adjuvant therapy with surgical resection for CRC in older Australians is required.
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Affiliation(s)
- Dhanushke Fernando
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Joseph Hanna
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Ryan Cohen
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jennifer Ryan
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
- Colorectal Surgery Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Papamichael D, Lopes GS, Olswold CL, Douillard JY, Adams RA, Maughan TS, Van Cutsem E, Venook AP, Lenz HJ, Heinemann V, Kaplan R, Bokemeyer C, Chibaudel B, Grothey A, Yoshino T, Zalcberg J, De Gramont A, Shi Q. Efficacy of anti-epidermal growth factor receptor agents in patients with RAS wild-type metastatic colorectal cancer ≥ 70 years. Eur J Cancer 2022; 163:1-15. [PMID: 35033994 DOI: 10.1016/j.ejca.2021.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Colorectal cancer (CRC) affects many older adults. We investigated the efficacy and safety of adding anti-epidermal growth factor receptor (EGFR) agents to doublet chemotherapy (DC) in older patients. METHODS Patients with RAS wild-type (WT) metastatic CRC (mCRC) receiving first-line DC + anti-EGFR (n = 1191) or DC alone (n = 729) from seven trials in the Aide de Recherche en Cancerologie Digestive database were included. The prognostic and predictive effects of age were investigated. Progression-free and overall survival (OS) were evaluated between age groups (≥70 vs <70) for DC + anti-EGFR. In addition, outcomes were compared between DC+/-anti-EGFR within age groups in three trials with a DC alone arm. Subsequently, the same analysis was conducted for left-sided tumours. Adverse events grade ≥3 (G3+) were compared between age groups. RESULTS Older (vs younger) patients receiving DC + anti-EGFR had similar progression-free survival (PFS) (8.7 vs 10.3 months; hazard ratio (HR) = 1.20 [0.96-1.49];p = 0.107) but inferior OS (21.3 vs 26.3; HR = 1.36 [1.08-1.72];p = 0.011). DC + anti-EGFR (vs DC alone) improved OS (23.9 vs 20.3; HR = 0.82 [0.70-0.95];p = 0.008) and PFS (11.2 vs 8.9; HR = 0.70 [0.60-0.82];p < 0.001) in younger but not older patients: OS (24.7 vs 17.6; HR [95% confidence interval {CI}] = 0.77 [0.58-1.04];p = 0.092) and PFS (9.1 vs 8.7; HR [95% CI] = 0.85[0.63-1.15];p = 0.287). In left-sided 'only' tumours, the following outcomes for older (vs younger) patients were observed. For DC + anti-EGFR, PFS 9 versus 11.2 months; HR1.10 (95% CI 0.83-1.46); p = 0.52, OS 25.6 vs 30.3 HR 1.32 (95% CI 0.97-1.79), p = 0.086. For DC + anti-EGFR (vs DC alone), PFS and OS for younger patients were 11.9 vs 9.2 months HR 0.60 (95% CI 0.47-0.78) p < 0.001 and 24.1 versus 23.3 months HR 0.84 (95% CI 0.67-1.04), respectively. For older patients, PFS and OS were 13.1 versus 8.5 months, HR 0.51 (95% CI, 0.28-0.93), P = 0.027 and 26.3 versus 16.5 months HR 0.49 (95% CI, 0.28-0.85), respectively. There was no significant difference in toxicity among different age groups. CONCLUSIONS Older (vs younger) patients with mCRC RAS WT patients had comparable toxicity and efficacy with the addition of anti-EGFR agents to chemotherapy.
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Affiliation(s)
| | - Guilherme S Lopes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Curt L Olswold
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jean-Yves Douillard
- University of Nantes, And Integrated Centers of Oncology ICO René Gauducheau Cancer, Nantes, France
| | | | | | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and University of Leuven, Leuven, Belgium
| | - Alan P Venook
- Helen Diller Family Comprehensive Cancer Center, USA
| | - Heinz-Josef Lenz
- Department of Gastrointestinal Onocology, Keck School of Medicine at USC, Los Angeles, CA, USA
| | - Volker Heinemann
- Department of Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Richard Kaplan
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Axel Grothey
- West Cancer Center and Research Institute, OneOncology, Germantown, TN, USA
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Japan
| | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Tapia Rico G, Karapetis C, Townsend AR, Piantadosi C, Padbury R, Roy A, Maddern G, Moore J, Carruthers S, Roder D, Price TJ. Do we know what to do with our nonagenarian and centenarian patients with metastatic colorectal cancer (mCRC)? Results from the South Australian mCRC registry. Acta Oncol 2018; 57:1455-1457. [PMID: 29775123 DOI: 10.1080/0284186x.2018.1473640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Gonzalo Tapia Rico
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | - Christos Karapetis
- Department of Medical Oncology, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Amanda R. Townsend
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | | | - Rob Padbury
- Department of Surgery, Flinders Medical Centre, Bedford Park, Australia
| | - Amitesh Roy
- Department of Medical Oncology, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Guy Maddern
- Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia
- Surgery, University of South Australia, Adelaide, Australia
| | - James Moore
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - David Roder
- Epidemiology, University of South Australia, Adelaide, Australia
| | - Timothy J. Price
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
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Colorectal cancer surgery in the very elderly patient: a systematic review of laparoscopic versus open colorectal resection. Int J Colorectal Dis 2017; 32:1237-1242. [PMID: 28667498 DOI: 10.1007/s00384-017-2848-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Colorectal cancer is the second most common cause of death from neoplastic disease in men and third in women of all ages. Globally, life expectancy is increasing, and consequently, an increasing number of operations are being performed on more elderly patients with the trend set to continue. Elderly patients are more likely to have cardiovascular and pulmonary comorbidities that are associated with increased peri-operative risk. They further tend to present with more locally advanced disease, more likely to obstruct or have disseminated disease. The aim of this review was to investigate the feasibility of laparoscopic colorectal resection in very elderly patients, and whether there are benefits over open surgery for colorectal cancer. METHODS A systematic literature search was performed on Medline, Pubmed, Embase and Google Scholar. All comparative studies evaluating patients undergoing laparoscopic versus open surgery for colorectal cancer in the patients population over 85 were included. The primary outcomes were 30-day mortality and 30-day overall morbidity. Secondary outcomes were operating time, time to oral diet, number of retrieved lymph nodes, blood loss and 5-year survival. RESULTS The search provided 1507 citations. Sixty-nine articles were retrieved for full text analysis, and only six retrospective studies met the inclusion criteria. Overall mortality for elective laparoscopic resection was 2.92% and morbidity 23%. No single study showed a significant difference between laparoscopic and open surgery for morbidity or mortality, but pooled data analysis demonstrated reduced morbidity in the laparoscopic group (p = 0.032). Patients undergoing laparoscopic surgery are more likely to have a shorter hospital stay and a shorter time to oral diet. CONCLUSION Elective laparoscopic resection for colorectal cancer in the over 85 age group is feasible and safe and offers similar advantages over open surgery to those demonstrated in patients of younger ages.
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Li Y, Wang S, Gao S, Yang C, Yang W, Guo S. Laparoscopic colorectal resection versus open colorectal resection in octogenarians: a systematic review and meta-analysis of safety and efficacy. Tech Coloproctol 2016; 20:153-62. [PMID: 26783029 DOI: 10.1007/s10151-015-1419-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 12/25/2015] [Indexed: 01/01/2023]
Abstract
Octogenarians are more often viewed as high-risk surgical candidates. This increased risk is attributed to an age-related decline in physical function and reserve capacity coupled with the presence of various underlying diseases. There are no current guidelines or consensus on the optimal treatment strategy for this cohort of complex patients. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of laparoscopic colorectal resection versus open colorectal resection in octogenarians. The meta-analysis was conducted following all aspects of the Cochrane Handbook for Systematic Reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic literature review was carried out using the following databases: MEDLINE, Embase, PubMed, the Cochrane Library, Google Scholar and OVID. Only studies comparing outcome of laparoscopic and open colorectal resections in the elderly population (≥80 years) were selected. The data collected included the patient demographics, interventions, observed outcome and sources of bias. When performing the statistical analysis, we used the odds ratio for categorical variables and the weighted mean difference for continuous variables. The results of this systematic review and pooled analysis demonstrated the safety and potential benefits of laparoscopic colorectal resection in octogenarians. LC can reduce the length of hospital stay, intraoperative blood loss, time to return of normal bowel function, and incidence of postoperative pneumonia, wound infection, and postoperative ileus.
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Affiliation(s)
- Y Li
- Department of Colorectal Surgery, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China.
| | - S Wang
- The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Medical University, No. 56 Xinjian Road South, Taiyuan, Shanxi, 030001, China
| | - S Gao
- Department of Colorectal Surgery, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China
| | - C Yang
- The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Medical University, No. 56 Xinjian Road South, Taiyuan, Shanxi, 030001, China
| | - W Yang
- Department of Gastroenterology, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China
| | - S Guo
- Department of Molecular Biology, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China
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Jorgensen M, Young J, Dobbins T, Solomon M. A mortality risk prediction model for older adults with lymph node-positive colon cancer. Eur J Cancer Care (Engl) 2015; 24:179-88. [DOI: 10.1111/ecc.12288] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2014] [Indexed: 01/20/2023]
Affiliation(s)
- M.L. Jorgensen
- Cancer Epidemiology and Services Research (CESR); Sydney School of Public Health; Sydney Medical School; University of Sydney; Sydney NSW Australia
| | - J.M. Young
- Cancer Epidemiology and Services Research (CESR); Sydney School of Public Health; Sydney Medical School; University of Sydney; Sydney NSW Australia
- Surgical Outcomes Research Centre (SOuRCe); Sydney Local Health District and University of Sydney; Sydney NSW Australia
| | - T.A. Dobbins
- Cancer Epidemiology and Services Research (CESR); Sydney School of Public Health; Sydney Medical School; University of Sydney; Sydney NSW Australia
| | - M.J. Solomon
- Surgical Outcomes Research Centre (SOuRCe); Sydney Local Health District and University of Sydney; Sydney NSW Australia
- Discipline of Surgery; University of Sydney; Sydney NSW Australia
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Vallribera Valls F, Landi F, Espín Basany E, Sánchez García JL, Jiménez Gómez LM, Martí Gallostra M, Salgado Cruz L, Armengol Carrasco M. Laparoscopy-assisted versus open colectomy for treatment of colon cancer in the elderly: morbidity and mortality outcomes in 545 patients. Surg Endosc 2014; 28:3373-8. [DOI: 10.1007/s00464-014-3597-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/09/2014] [Indexed: 12/13/2022]
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Serra-Rexach JA, Jimenez AB, García-Alhambra MA, Pla R, Vidán M, Rodríguez P, Ortiz J, García-Alfonso P, Martín M. Differences in the therapeutic approach to colorectal cancer in young and elderly patients. Oncologist 2012; 17:1277-85. [PMID: 22923453 DOI: 10.1634/theoncologist.2012-0060] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To analyze differences in the therapeutic approach to and tumor-related mortality of young and elderly colorectal cancer (CRC) patients. PATIENTS AND METHODS This was a descriptive study of a retrospective cohort, based on administrative databases, of all patients with CRC diagnosed or treated in our institution. We extracted data on sociodemographic characteristics, comorbidity, type of cancer, type of treatment received, survival time, and cause of death. We compared differences between a young group (YG) (age <75 years) and an older group (OG) (age ≥75 years) and assessed the variables associated with receiving different therapeutic options (multivariate analysis) and with survival time (Cox proportional hazards models). RESULTS The study included 503 patients (YG, 320; OG, 183), with mean ages of 63.1 years in the YG and 81.8 years in the OG. No differences were observed between the groups in degree of differentiation, extension, tumor stage, or comorbidity. After adjustment for gender, comorbidity, and tumor localization and extension, YG patients were more likely than OG patients to receive surgery, radiotherapy, and chemotherapy and less likely to receive palliative care. After a median follow-up of 36.5 months, YG patients had a longer tumor-specific survival time than OG patients (36.41 months vs 26.05 months). After further adjustment, the YG had a lower tumor-specific mortality risk (hazard ratio, 0.66) than the OG. CONCLUSION In comparison with younger patients, elderly CRC patients are undertreated, mainly because of their age and not because of their tumor type or comorbidity. Elderly patients have a significantly shorter tumor-specific survival time, partially because of this undertreatment.
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Affiliation(s)
- José A Serra-Rexach
- Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.
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Tan KK, Koh FHX, Tan YY, Liu JZ, Sim R. Long-term outcome following surgery for colorectal cancers in octogenarians: a single institution's experience of 204 patients. J Gastrointest Surg 2012; 16:1029-36. [PMID: 22258874 DOI: 10.1007/s11605-011-1818-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/28/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of colorectal cancer in elderly patients is likely to increase with an aging population. The aims of this study are to review our experience in the surgical management of octogenarians with colorectal cancers and to identify factors that influence the short-term and long-term outcomes. METHODS A retrospective review of all octogenarians who underwent surgery for colorectal cancer from December 2002 to October 2008 was performed. RESULTS We identified 204 patients with a median age of 84 years (range, 80-97 years). The majority of patients had an American Society of Anesthesiologists score ≥3 (n = 142, 69.6%) and a Charlson Comorbidity Index of ≤3 (n = 128, 62.7%). Emergency surgery was performed in 83 (40.7%) patients. Left-sided malignancy was seen in 138 patients (67.6%). Most of the patients had either stage II (n = 75, 36.8%) or III (n = 69, 33.8%) diseases. The 30-day mortality rate was 16.2% (n = 33). After multivariate analysis, the independent variables predicting worse perioperative complications and death were age >85 years old, emergency surgery, and Charlson Comorbidity Index >3. The median follow-up for the 171 remaining patients was 27 months (range, 2-92 months). The 30-day readmission rate was 2.9% (n = 5). Thirty-one (21.2%) of 146 patients who survived curative surgery developed recurrent disease. Seventy (34.3%) patients died from various etiologies after their first 30 days postoperatively (60% cancer-specific with median survival of 15 months and 40% noncancer-related with median survival of 14 months). Overall and disease-free survivals were adversely affected in patients with advanced malignancy and in those with severe perioperative complications. CONCLUSIONS Surgery for octogenarians with colorectal cancers is associated with significant morbidity and mortality rates which are associated with advanced age, emergency surgery, and Charlson Comorbidity Index >3. Long-term survival is dependent on the stage of the malignancy and the presence of severe perioperative complications.
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Affiliation(s)
- Ker-Kan Tan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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Management of Advanced Colon Cancer in a Community Hospital—Impact of Age on Clinical Management and Survival. J Gastrointest Cancer 2011; 43:426-30. [DOI: 10.1007/s12029-011-9308-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Fornaro L, Baldi GG, Masi G, Allegrini G, Loupakis F, Vasile E, Cupini S, Stasi I, Salvatore L, Cremolini C, Vincenzi B, Santini D, Tonini G, Graziano F, Ruzzo A, Canestrari E, Magnani M, Falcone A. Cetuximab plus irinotecan after irinotecan failure in elderly metastatic colorectal cancer patients: clinical outcome according to KRAS and BRAF mutational status. Crit Rev Oncol Hematol 2010; 78:243-51. [PMID: 20619672 DOI: 10.1016/j.critrevonc.2010.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 05/26/2010] [Accepted: 06/10/2010] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Scarce data are available about safety and efficacy of cetuximab in elderly metastatic colorectal cancer (mCRC) patients. PATIENTS AND METHODS We retrospectively analysed 54 irinotecan-refractory mCRC patients aged≥70 years treated with cetuximab plus irinotecan and evaluated clinical outcome according to KRAS and BRAF mutational status. RESULTS Median age was 73 years (70-82). Main grade 3-4 toxicities were skin rash (15%), diarrhea (19%) and neutropenia (13%). Irinotecan dose reduction was necessary in 39% of patients. Fifty-two (96%) patients were analysed for KRAS and BRAF status. The 29 KRAS wild-type patients achieved better RR (31% vs 4%; p=0.030) and median PFS (4.21 months vs 3.95 months; p=0.034; HR: 0.50, 95% CI: 0.27-0.95) when compared with KRAS mutated ones. RR (41% vs 3%; p=0.001) and mPFS (4.57 months vs 3.78 months, p=0.001; HR: 0.35, 95% CI: 0.19-0.66) were significantly higher among the 22 KRAS and BRAF wild-type patients compared to the 30 KRAS or BRAF mutated ones. CONCLUSION Cetuximab plus irinotecan has a favourable safety profile in elderly mCRC patients, but a reduced dose of irinotecan should be considered. Such a combination can be a useful option for elderly KRAS and BRAF wild-type patients.
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Affiliation(s)
- Lorenzo Fornaro
- U.O. Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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