Efficacy and toxicity of adjuvant chemotherapy in elderly patients with colon carcinoma

Fata, F. Ramón de; Mirza, Ayoub; Wood, G. Craig; Nair, Suresh; Law, Amy; Gallagher, James; Ellison, Neil M.; Bernath, Albert M.

doi:10.1002/cncr.10430

Cited by 66 publications

(38 citation statements)

References 22 publications

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“…These pooled results from randomized controlled trials are in line with most other retrospective reports, which found improved survival for adjuvant 5-FU/LV or capecitabine in stage III colorectal cancer, regardless of patient age [16,17,22,44,45] . Some retrospective data describe a reduced effect of 5-FU-based chemotherapy with rising patient age [18] .…”

Section: Evidence From Large Randomized Controlled Trialssupporting

confidence: 80%

“…Currently, no age restriction for adjuvant chemotherapy in colorectal cancer patients can be determined, as chronological patient age alone has no predictive value [17] . The use of oxaliplatin for elderly patients is still a matter of debate.…”

Section: Resultsmentioning

confidence: 99%

“…However, most studies use 70 years [13,15,16] or 75 years [17,18] as the cutoff point. Many clinical trials have age as exclusion criteria, which renders patients older than 70 years underrepresented in studies [9] .…”

mentioning

confidence: 99%

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Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

Nitsche¹,

Stöß²,

Friess³

2017

Gastrointest Tumors

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Background: Adjuvant chemotherapy has become the standard form of treatment for all patients with stage III colorectal cancer and is also recommended for patients with stage II disease and defined risk factors. However, clinical studies that evaluate the effect of adjuvant treatment regimens have a selection bias in favor of younger patients, so that even retrospective subgroup analyses cannot define the best therapeutic procedure in elderly patients with comorbidities. Summary: As long as the role of adjuvant chemotherapy in elderly colorectal cancer patients is not investigated in comprehensive trials, no clear recommendations are possible. Key Message: An exploratory review of the relevant literature revealed that a formal meta-analysis concerning adjuvant chemotherapy in elderly patients with colorectal cancer is not feasible due to varying definitions of elderly patients, inclusion and exclusion criteria, and a plethora of chemotherapeutic regimens. Practical Implications: Given the high incidence of colorectal cancer and the median age of 68 years for patients at the time of diagnosis, health economic considerations should promote randomized controlled trials regarding the role of adjuvant chemotherapy in the elderly.

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Section: Evidence From Large Randomized Controlled Trialssupporting

confidence: 80%

Section: Resultsmentioning

confidence: 99%

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Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

Nitsche¹,

Stöß²,

Friess³

2017

Gastrointest Tumors

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“…Während die Gabe von Capecitabine ihre Effektivität auch bei Älteren zeigte, war die Kombination aus Fluropyrimidin mit Oxaliplatin bei Älteren nicht effektiv [866]. Das Lebensalter eines Patienten hat somit keinen alleinigen prädiktiven Wert [867]. Bei älteren Patienten ist der Benefit einer adjuvanten Therapie allerdings kleiner bei gleichzeitig höherer Toxizität.…”

Section: Multiviszerale Resektionunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

132

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“…On this basis, the elderly could also be treated with full doses of thymidylate synthase inhibitors. Even Fata et al [17] did not observe a significant increase of toxicity in the adjuvant chemotherapeutic treatment of elderly compared with their younger counterparts; however, they state that the data regarding age cannot be generalized to patients aged 175 years. In view of the very advanced age of our patients, we employed a reduced dose intensity (33%).…”

Section: Discussionmentioning

confidence: 93%

Favorable Toxicity Profile of Raltitrexed in Elderly Patients Treated for Colorectal Cancer: A Case Series

Franchi

Pastore²,

Caporale³

et al. 2003

Gerontology

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Background: Age-related physiological changes may lead to an increased toxicity of chemotherapy in the elderly, thus making tumor treatment difficult in this increasing subset of patients. Objective: Since many trials claimed a favorable therapeutic index with raltitrexed, the aim of our preliminary study was to evaluate the anticancer activity and the toxic profile of this drug in the elderly. Methods: Thirteen elderly patients with colorectal cancer, aged 75–90 years, were enrolled in a monochemotherapy treatment with raltitrexed. Due to their advanced age, the drug was administered with a 33% reduction of the dose. Results: One partial response, four disease stabilizations, and two disease progressions were observed in 7 patients with advanced colorectal cancer. The patients with response or disease stabilisation had a satisfactory time to progression. Four out of 6 patients treated in the adjuvant setting for Dukes’ C colorectal cancer remain disease free at observation periods of 15+ to 29+ months. Toxicity was virtually absent in all patients. Conclusions: The activity of monochemotherapy with raltitrexed appears to be appealing, above all because it is observed in the absence of toxicity. Though recent reports suggest some concern about severe complications of treatment with raltitrexed, administration of reduced doses of this drug seems to be a putative therapy for those patients who, because of their age, are highly susceptible to the adverse effects of chemotherapy.

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Efficacy and toxicity of adjuvant chemotherapy in elderly patients with colon carcinoma

Cited by 66 publications

References 22 publications

Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

S3-Leitlinie – Kolorektales Karzinom

Favorable Toxicity Profile of Raltitrexed in Elderly Patients Treated for Colorectal Cancer: A Case Series

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