Effectiveness and safety of first-line bevacizumab plus FOLFIRI in elderly patients with metastatic colorectal cancer: Results of the ETNA observational cohort

Rouyer, Magali; Fourrier‐Réglat, Annie; Smith, Denis; Bécouarn, Y.; Guimbaud, Rosine; Tubiana-Mathieu, Nicole; Robinson, Philip; Jové, Jérémy; Grelaud, Angela; Noïze, Pernelle; Moore, Nicholas; Ravaud, Alain

doi:10.1016/j.jgo.2016.03.004

Cited by 14 publications

(23 citation statements)

References 15 publications

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“…The difference, however, accounted only for a few weeks and no difference in OS was observed. A decrease in OS of elderly patients receiving bevacizumab compared to younger patients has been reported by observational studies and subgroup analyses of clinical trials [32][33][34][35] . Slight reductions in both PFS and OS were observed in patients ≥ 70 years compared to younger patients treated with first-line bevacizumab-combination regimens in a large German observational study [36] .…”

Section: Discussionmentioning

confidence: 79%

Outcome of Colorectal Cancer Patients Treated with Combination Bevacizumab Therapy: A Pooled Retrospective Analysis of Three European Cohorts from the Angiopredict Initiative

Betge¹,

Barat

Murphy³

et al. 2016

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Background/Aims: This study is aimed at analyzing the survival rates and prognostic factors of stage IV colorectal cancer patients from 3 European cohorts undergoing combination chemotherapy with bevacizumab. Methods: Progression free-survival (PFS) and overall survival (OS) were analyzed in 172 patients using the Kaplan-Meier method and uni- and multivariable Cox proportional hazards regression models. Results: The median PFS was 9.7 and the median OS 27.4 months. Patients treated at centers in Germany (n = 97), Ireland (n = 32), and The Netherlands (n = 43) showed a median PFS of 9.9, 9.2, and 9.7 months, OS of 34.0, 20.5, and 25.1 months, respectively. Patients >65 years had a significantly shorter PFS (9.5 vs. 9.8 months) but not OS (27.4 vs. 27.5 months) than younger patients. High tumor grade (G3/4) was associated with a shorter PFS, T4 classification with both shorter PFS and OS. Fluoropyrimidine (FP) chemotherapy backbones (doublets and single) had comparable outcomes, while patients not receiving FP backbones had a shorter PFS. In multivariable analysis, age and non-FP backbone were associated with inferior PFS, T4 classification and therapy line >2nd were significantly associated with poor PFS and OS. Conclusion: The observed survival rates confirm previous studies and demonstrate reproducible benefits of combination bevacizumab regimens. Classification T4, non-FP chemotherapy backbone, and age >65 were associated with inferior outcome.

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Section: Discussionmentioning

confidence: 79%

Outcome of Colorectal Cancer Patients Treated with Combination Bevacizumab Therapy: A Pooled Retrospective Analysis of Three European Cohorts from the Angiopredict Initiative

Betge¹,

Barat

Murphy³

et al. 2016

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“…As in clinical trials, older patients may be partly excluded from receiving treatment with targeted therapies in real‐life settings. The unwillingness of physicians to prescribe anticancer medications in older adults may be greater with regard to newer medications, as recently demonstrated by McCleary et al 11 However, there is increasing evidence of a satisfactory benefit‐risk ratio of such medications in this population . Except for age, other factors that may influence the decision to prescribe conventional chemotherapy alone or a treatment including a targeted therapy were related to mCRC.…”

Section: Discussionmentioning

confidence: 98%

“…In routine clinical practice, observational studies showed that targeted therapies are prescribed to patients who would be excluded from clinical trials because of advanced age or other frailty parameters (eg, comorbidities, physical incapacity, etc). When treated by targeted therapies, older adults have similar survival outcomes to those of younger patients without major safety issues . Conversely, an older age still seems to be a barrier to offering treatment with anticancer medications and especially targeted therapies .…”

mentioning

confidence: 99%

“…When treated by targeted therapies, older adults have similar survival outcomes to those of younger patients without major safety issues. 9,10 Conversely, an older age still seems to be a barrier to offering treatment with anticancer medications and especially targeted therapies. 11,12 In the absence of clear recommendations for older patients, treatment choice is often difficult owing to specific characteristics that need to be taken into account, such as comorbidities, dependency, biological abnormalities, and social environment.…”

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confidence: 99%

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Treatment Modalities and Survival in Older Adults with Metastatic Colorectal Cancer in Real Life

Gouverneur

Bezin

Jové

et al. 2019

J American Geriatrics Society

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OBJECTIVES Metastatic colorectal cancer (mCRC) is increasingly treated with targeted therapies, but little is known about real‐life mCRC treatment in older adults. The aims were to describe the real‐life first‐line treatment modalities in older adult mCRC patients, to identify factors associated with treatment modalities, and to evaluate survival with regard to treatment modalities. PATIENTS AND METHODS A cohort of mCRC patients aged 65 years and older at diagnosis was identified between 2009 and 2013 using French national healthcare insurance system claims data. Treatment modalities were: treatment with one or more anticancer medication vs best supportive care and, among treated patients, treatment with targeted therapy vs conventional chemotherapy alone. Multivariate logistic regression was used to identify factors associated with treatment by anticancer medication and by targeted therapy. Cox proportional hazards models were used to assess the independent effect of treatment modalities on overall survival while adjusting for baseline covariates identified with logistic regression. RESULTS A total of 503 patients were included with a median age of 78 years (54% were men). Of these, 299 (59%) were treated with anticancer medications. Among treated patients, 131 (44%) received targeted therapy. In multivariate analysis, age 75 years or older, renal failure, malnutrition, and five or more concomitant medications were associated with a lower likelihood of treatment with anticancer medications. Among treated patients, age 75 years or older, history of cancer, lymph node metastases, and a single metastatic site were associated with a lower likelihood of treatment with targeted therapy. Multivariate Cox proportional hazards models found that treatment with any anticancer medication tended to be associated with a lower risk of death; treatment with targeted therapy was not significantly associated. CONCLUSION A more appropriate prescription of anticancer medications in the older adult will require the definition of more explicit criteria to avoid undertreatment. The real benefit of targeted therapies vs conventional chemotherapy alone needs to be confirmed in this population. J Am Geriatr Soc 67:913–919, 2019.

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“…However, an increase in thromboembolic events is observed in patients >65 years [25, 27, 28]. For cetuximab and panitumumab, efficacy and safety are similar for patients ≤65 and >65 years [29].…”

Section: Introductionmentioning

confidence: 99%

The effect of geriatric intervention in frail elderly patients receiving chemotherapy for colorectal cancer: a randomized trial (GERICO)

et al. 2017

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BackgroundBetter surgical techniques, chemotherapy and biological therapy have improved survival in patients with colorectal cancer (CRC), most markedly in younger patients. About half of patients over 70 years receive dose reductions or early treatment discontinuation of the planned adjuvant or first-line treatment due to side effects. The Comprehensive Geriatric Assessment (CGA) is a multidisciplinary evaluation of an elderly individual’s health status. This assessment in older patients with cancer can predict survival, chemotherapy toxicity and morbidity.MethodsThis randomized phase II trial (GERICO) is designed to investigate whether comprehensive geriatric assessment and intervention before and during treatment with chemotherapy in frail elderly patients with stages II–IV CRC will increase the number of patients completing chemotherapy. All patients ≥70 years in whom chemotherapy for CRC is planned to start at Herlev and Gentofte Hospital are screened for frailty using the G8 questionnaire at the first visit to the outpatient clinic. The G8 questionnaire is a multi-domain screening tool to identify frail or vulnerable patients at risk of increased toxicity and morbidity. Frail patients are offered inclusion and are then randomized to two groups (the intervention group and the control group). Patients in the intervention group receive a full geriatric assessment of comorbidity, medication, psycho-cognitive function, physical, functional and nutrition status, and interventions are undertaken on identified health issues. Simultaneously, they are treated for their cancer according to international guidelines. Patients in the control group receive the same chemotherapy regimens and standard of care. Primary outcome is number of patients completing scheduled chemotherapy at starting dose. Secondary outcomes are dose reductions, treatment delays, toxicity, time to recurrence, survival, cancer-related mortality and quality of life.DiscussionThis ongoing trial is one of the first to evaluate the effect of geriatric intervention in frail elderly patients with CRC. The trial will provide new and valuable knowledge about whether it is beneficial for the elderly patient undergoing chemotherapy to be treated simultaneously by a geriatrician.Trial registration ClinicalTrials.gov ID: NCT02748811. The trial was registered retrospectively; registration date 04/28/2016.

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Effectiveness and safety of first-line bevacizumab plus FOLFIRI in elderly patients with metastatic colorectal cancer: Results of the ETNA observational cohort

Cited by 14 publications

References 15 publications

Outcome of Colorectal Cancer Patients Treated with Combination Bevacizumab Therapy: A Pooled Retrospective Analysis of Three European Cohorts from the Angiopredict Initiative

Outcome of Colorectal Cancer Patients Treated with Combination Bevacizumab Therapy: A Pooled Retrospective Analysis of Three European Cohorts from the Angiopredict Initiative

Treatment Modalities and Survival in Older Adults with Metastatic Colorectal Cancer in Real Life

The effect of geriatric intervention in frail elderly patients receiving chemotherapy for colorectal cancer: a randomized trial (GERICO)

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