Bevacizumab in first-line treatment of elderly patients with metastatic colorectal cancer: German community-based observational cohort study results

Abstract

BackgroundTo evaluate the efficacy of first-line bevacizumab-based chemotherapy for untreated metastatic colorectal cancer (mCRC) based on age.MethodsEligibility criteria focused on M1 disease without prior palliative chemotherapy. Choice of chemotherapy regimen was at the physician’s discretion. Predefined efficacy endpoints were response rate, progression-free and overall survival (PFS, OS). Patients were analysed by age (<70 vs. ≥70 years, <75 vs. ≥75 years).ResultsOf 1777 patients, 27% and 12% were ≥70 and ≥75 years, respectively. PFS was shorter in elderly patients (<70 vs. ≥70 years: 10.5 vs. 9.5 months, p = 0.074; <75 vs. ≥75 years: 10.5 vs. 8.9 months, p = 0.00019), as was OS (<70 vs. ≥70 years: 25.8 vs. 22.7 months, p < 0.0008; <75 vs. ≥75 years: 25.8 vs. 20.8 months; p < 0.0001). In the groups <70 and <75 years, PFS was longer in those receiving oxaliplatin-/irinotecan-containing regimens vs. those receiving 5-FU/capecitabine (<70 years: 10.6 vs. 9.0 months; p = 0.0065; <75 years: 10.6 vs. 9.2 months; p = 0.028); no difference in PFS was observed between oxaliplatin-/irinotecan-containing regimens vs. 5-FU/capecitabine regimens in both elderly age-group comparisons (≥70 years: 9.7 vs. 9.2 months; ≥75 years: 8.3 and 9.0 months).ConclusionFirst-line bevacizumab-based chemotherapies were effective in German mCRC patients ≥75 years of age, but PFS and OS were significantly shorter in this age group vs. younger patients.

Efficacy and Safety of Bevacizumab in Combination with Chemotherapy for Colorectal Cancer – A Real World Study in China

“…(34) First-line bevacizumab based CTs were effective in patients > 75 years of age, however shorter PFS and OS was observed when compared to younger patients. (35) In our study, the Cox proportional hazard ratios showed that patients aged ≤ 50 years were more responsive to bevacizumab treatment than patients aged > 50 years. However, the current study does not draw any solid conclusion as only 20 patients out of 51 patients were aged ≤ 50 years.…”

Efficacy and Safety of Bevacizumab Combined With Fluoropyrimidine Monotherapy for Unfit or Older Patients With Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis

“…After exclusion of duplicates and irrelevant studies, 8 reports were deemed to be eligible for the meta-analysis ( Figure 1). 13,[18][19][20][21][22][23][24] Of the 8 studies, 3 were multicenter RCTs (n ¼ 558) 13,18,19 and 5 were phase II or prospective series (n ¼ 224). [20][21][22][23][24] The characteristics of the studies included are reported in Supplemental Table 1 (available in the online version).…”

“…13,[18][19][20][21][22][23][24] Of the 8 studies, 3 were multicenter RCTs (n ¼ 558) 13,18,19 and 5 were phase II or prospective series (n ¼ 224). [20][21][22][23][24] The characteristics of the studies included are reported in Supplemental Table 1 (available in the online version). Patient age for inclusion was 70 or 75 years in 5 studies 13,[20][21][22][23] and 2 studies, 18,24 respectively, and 65 years in 1 trial.…”

Anti-angiogenic agents in metastatic colorectal cancer

“…PFS in the elderly patients was similar to their younger counterparts though median OS declined with increasing age [47] . Interestingly however, in another large observational cohort study of 1777 treatmentnaive German mCRC patients, those ≥ 75 years of age had a significantly lower PFS and median OS when compared to those < 75 years of age (PFS: 10.5 mo vs 8.9 mo; P = 0.00019; OS: 25.8 mo vs 20.8 mo; P < 0.0001) [48] . In a multicenter phase Ⅱ study by the Hellenic Oncology Research Group, the combination of capecitabine, oxaliplatin, and bevacizumab (AVELOX) was proven to be safe and effective in the first-line treatment of elderly patients (≥ 70 years old) [49] .…”