Comparative analysis of the efficacy and safety of chemotherapy with oxaliplatin plus fluorouracil/leucovorin between elderly patients over 65 years and younger patients with advanced gastric cancer

Abstract

Background A chemotherapy regimen with oxaliplatin, fluorouracil, and leucovorin is commonly used to treat advanced gastric cancer (AGC). This study was designed to compare the efficacy and the safety of oxaliplatin plus fluorouracil/leucovorin administered biweekly (mFOL-FOX6) between elderly patients aged over 65 years and younger counterparts with AGC. Methods This analysis included 82 AGC patients (C65:31, \65:51). Patients with previously untreated chemo-naïve advanced adenocarcinoma of the stomach received oxaliplatin 85 mg/m 2 , 5-FU bolus 400 mg/m 2 on day 1 and 5-FU 1,500 mg/m 2 , leucovorin 75 mg/m 2 22 h infusion on days 1 and 2 every 2 weeks. The aim of the study was to compare efficacy and safety, including response rate (RR), progression-free survival (PFS), overall survival, and grade C3 adverse events, between patients aged C65 years and patients aged \65 years. Results Median progression-free survival (PFS) was not significantly different between both groups (C65: 5.8 months, \65: 5.7 months, respectively, HR 0.77, 95% CI: 0.44-1.16, P = 0.18). Median overall survival was not significantly different between both groups (C65: 10.3 months, \65: 9.5 months HR 0.83, 95% CI: 0.50-1.37, P = 0.46). The rate of grade 3 or 4 neutropenia did not differ with age group (C65: 51.6%, \65: 43.1%); nor did the rates of neutropenic fever (C65: 16.1%, \65: 5.9%), and infection without neutropenia (C65: 3.2%,\65: 3.9%). Rates of grade C3 toxicities such as thrombocytopenia, nausea/vomiting, or peripheral neuropathy were not significantly different between the two groups. Conclusions mFOLFOX6 maintains its efficacy and safety in elderly patients aged over 65 years in comparison with AGC patients aged\65 years. Its judicious use should be considered regardless of age.

Advanced age and liability to oxaliplatin‐induced peripheral neuropathy: post hoc analysis of a prospective study

“…These studies have shown that elderly patients with cancer with good functional status and without significant co-morbidities may obtain treatment benefits comparable to younger patients [5,6]. However, taking into account that enrolled patients were considered as being eligible for inclusion by the treating physician, these studies should be interpreted with caution because of pre-trial selection bias.…”

Efficacy and Safety of FOLFIRI Regimen in Elderly Versus Nonelderly Patients with Metastatic Colorectal or Gastric Cancer

“…In contrast to CRC, the experience of irinotecan‐based chemotherapy in elderly patients is still limited in GC. Some studies indicated that oxaliplatin‐based doublet regimens could also be an option in these patients .…”

Achieving sequential therapy in advanced gastric cancer: the importance of appropriate patient management for the elderly and/or those with ascites

“…Clinical trial data that are available regarding the treatment of elderly patients with AGC is limited and is mostly derived from phase II studies conducted in elderly patients, age subgroup analyses of phase III studies, and retrospective analyses of elderly patient populations. Overall, evidence from these clinical trials suggests that chemotherapy is feasible in elderly patients with AGC [14,[24][25][26][27][28], but elderly patients with AGC are less likely to receive multiple lines of chemotherapy than younger patients [14,15]. For example, studies of first-line chemotherapy in elderly vs younger patients have reported rates of second-line chemotherapy of 38.7% vs 62.7% [14] and 24% vs 68% [15].…”

“…Because of poor PS, elderly patients and patients with massive ascites may not be considered for a subsequent line(s) of treatment, particularly because these patients have decreased organ function and comorbidities and, therefore, are at greater risk of toxicity and complications [14][15][16][17][18]. Good patient management will likely play an important role in sequential therapy by minimizing the adverse effects of treatment while maximizing the benefits.…”