Impact of age and medical comorbidity on adjuvant treatment outcomes for stage III colon cancer: a pooled analysis of individual patient data from four randomized, controlled trials

Abstract

Results further support consideration of XELOX or FOLFOX as standard treatment options for the adjuvant management of stage III CC in all age groups and in patients with comorbidities, consistent with those who were eligible for these clinical trials.

S3-Leitlinie – Kolorektales Karzinom

“…Daher muss bei der Frage nach dem Einfluss des Alters auf die Gabe einer adjuvanten Chemotherapie auf gepoolte Analysen klinischer Studien zurückgegriffen werden. Gepoolte Analysen der NSABP-C08, XELOXA, X-ACT und AVANT-Studien ergaben, dass in allen Altersgruppen eine Therapie mit FOLFOX/XELOX diskutiert werden kann [864]. Die Hazard Ratio für eine adjuvante Therapie mit Oxaliplatin erreichte bei Patienten > 69 Jahre 0,78 für das Gesamtüberleben, wohingegen die jüngeren Patienten mit einer HR von 0,62 einen deutlich höheren Benefit von der Oxaliplatin-haltigen Therapie hatten.…”

“Real World” Effectiveness of Different Postoperative Adjuvant Chemotherapy Regimens in Stage III Colon Cancer Patients

“…However, cost effectiveness and quality of life of adjuvant chemotherapy are major concerns in the "real world" [13,14]. Uncertainty remains regarding the optimal treatment of elderly patients and patients with comorbidities [8][9][10]. Although FOLFOX as adjuvant treatment for stage III colon cancer are generally well followed in daily practice because of additional 6-8% disease free survival benefit for patients comparing with 5-FU regimen alone, realworld efficacy of oxaliplatin in stage III colon cancer remained unclear.…”

“…This database was first established in 1985 and a revised data record form was implemented in 1995 (9). Data collected included six major parts comprising detailed family history, demographic variables, preoperative evaluation, operation records, multidisciplinary treatment including chemotherapy and postoperative follow-ups.…”

“…However, clinically there are several factors limiting clinician to adhere to FOLFOX regimen such as consideration of neurotoxicity of oxaliplatin and patients' comorbidities. In addition to patient age affecting choice of adjuvant therapy, there is also inconsistency regarding oxaliplatin benefit in patients age older than 70 [8,9].…”

“…Furthermore, the impact of medical comorbidity remained to be further clarified in previous studies [9]. Some also argued against participants in RCTs are usually younger, and healthier than the general cancer population.…”