FOLFOX2 in the Treatment of Advanced Colorectal Cancer: A Comparison Between Elderly and Middle Aged Patients

Abstract

The effectiveness of chemotherapy in elderly patients is still a matter of debate. We analyzed the toxicity and efficacy of the original FOLFOX2 regimen in middle aged and elderly patients affected by metastatic colorectal cancer. Consecutive patients with metastatic CRC and measurable disease were eligible. Seventy-eight partially pretreated patients were enrolled: 58 patients were defined as middle aged (<70 years) and 20 were elderly patients (>70 years). Elderly patients in comparison to middle-aged patients in a higher percentage were males. No significant differences were found in hematological and non-hematological toxicity between the two groups. No significant differences were found in the response rates, time to progression (5.9 vs. 6.0 months respectively), or median overall survival (20.9 and 21.8 months, respectively) between middle aged and elderly patients. The FOLFOX2 regimen provides equivalent feasibility, efficacy, and survival gain in middle-aged and in elderly patients with metastatic CRC.

Liver Resection for Colorectal Metastases in Older Adults: A Paired Matched Analysis

“…The majority of data currently available in the literature come from retrospective analyses of Phase III studies on metastatic disease, in which it has been observed that some participants initially treated with palliative therapy became susceptible to radical resection of their hepatic metastases . Moreover, many studies have demonstrated that the use of antiblastic chemotherapy in the older adults with CRC is safe and feasible, especially in those with good performance status …”

“…Few data are available on the use of antiblastic chemotherapy in the neoadjuvant setting for liver colorectal metastases; conversely, many studies have demonstrated that chemotherapy can be safely used in older adults with metastatic CRC …”

Systematic Review of Treatments for Colorectal Metastases in Elderly Patients to Guide Surveillance Cessation Following Hepatic Resection for Colorectal Liver Metastases

“…77,81,85,93 Elderly patients also experienced higher toxicity in 6/19 studies (32%) 71,85,98 but not significantly different in 13/19 studies (68%), 40,70,72,73,75,77,[82][83][84]86,89,91,92 and, more hospitalizations in 2 reporting studies (100%). 85,91 The key chemotherapy outcomes were that elderly patients experienced:worse overall response rate in 1/13 studies (8%) 71 but not significantly different in 12/13 studies (92%), 70,74,75,77,78,[82][83][84]86,87,89,92 worse overall survival in 7/24 studies (29%) 6,40,78,84,[96][97][98] and not significantly different in 17/24 studies (71%), 71,[73][74][75]77,[79]…”

“…85,91 The key chemotherapy outcomes were that elderly patients experienced:worse overall response rate in 1/13 studies (8%) 71 but not significantly different in 12/13 studies (92%), 70,74,75,77,78,[82][83][84]86,87,89,92 worse overall survival in 7/24 studies (29%) 6,40,78,84,[96][97][98] and not significantly different in 17/24 studies (71%), 71,[73][74][75]77,[79][80][81][82][83]86,87,[89][90][91][92]95 and interestingly, progression-free survival for elderly patients was significantly better in 2/20 studies (10%) 86,87 but worse in 2/20 studies (10%) 96,97 and not significantly different in 16/20 studies (80%). 40,71,[73][74][75]…”

“…40 The 2 studies which unexpectedly showed better progression-free survival in the elderly were both reported by Folprecht et al 86,87 who retrospectively analyzed source data from several 5-FU clinical trials and although the authors did not offer any explanantion for the finding, they suggested the observation has limited clinical relevance. 86 Only 1 75 of the 33 reviewed studies indicated using a geriatric evaluation tool which was administered by the authors' Onco-Geriatric Unit such that only fit elderly patients with no functional dependence in activities of daily living (ADL) scale, no relevant comorbidities, and no geriatric syndromes were considered eligible for the study. The authors did not give any further details such as the name of the geriatric evaluation tool or a suitable reference.…”