How are elderly patients treated after a diagnosis of metastatic colorectal cancer in real‐life practice? A study in a French teaching hospital

Gouverneur, Amandine; Rouyer, Magali; Grelaud, Angela; Robinson, Philip; Colombani, F.; Terrebonne, Éric; Smith, Denis; Fourrier‐Réglat, Annie; Noïze, Pernelle

doi:10.1111/fcp.12243

Cited by 6 publications

(7 citation statements)

References 17 publications

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“…In addition, while colon cancer survival has improved over the past decades, 5,6 the improvement in survival lagged for older people, creating a larger age gap in survival 3,5 . This reduced survival for older adults may be a consequence of socioeconomic (ie, social isolation, disadvantaged groups or low socioeconomic status), 7,8 patient‐related (ie, comorbidities, frailty, lower tolerance of multimodality treatments) 9,10 and healthcare‐related (ie, suboptimal cancer management, diagnostic delays) factors 11‐13 . These factors individually, or in combination, could contribute to colon cancer diagnosis through emergency care, and/or, more advanced cancer stage at diagnosis 14 .…”

Section: Introductionmentioning

confidence: 99%

Age disparities in stage‐specific colon cancer survival across seven countries: An International Cancer Benchmarking PartnershipSURVMARK‐2 population‐based study

Pilleron

Charvat

Araghi

et al. 2020

Intl Journal of Cancer

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We sought to understand the role of stage at diagnosis in observed age disparities in colon cancer survival among people aged 50 to 99 years using population‐based cancer registry data from seven high‐income countries: Australia, Canada, Denmark, Ireland, New Zealand, Norway and the United Kingdom. We used colon cancer incidence data for the period 2010 to 2014. We estimated the 3‐year net survival, as well as the 3‐year net survival conditional on surviving at least 6 months and 1 year after diagnosis, by country and stage at diagnosis (categorised as localised, regional or distant) using flexible parametric excess hazard regression models. In all countries, increasing age was associated with lower net survival. For example, 3‐year net survival (95% confidence interval) was 81% (80‐82) for 50 to 64 year olds and 58% (56‐60) for 85 to 99 year olds in Australia, and 74% (73‐74) and 39% (39‐40) in the United Kingdom, respectively. Those with distant stage colon cancer had the largest difference in colon cancer survival between the youngest and the oldest patients. Excess mortality for the oldest patients with localised or regional cancers was observed during the first 6 months after diagnosis. Older patients diagnosed with localised (and in some countries regional) stage colon cancer who survived 6 months after diagnosis experienced the same survival as their younger counterparts. Further studies examining other prognostic clinical factors such as comorbidities and treatment, and socioeconomic factors are warranted to gain further understanding of the age disparities in colon cancer survival.

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Section: Introductionmentioning

confidence: 99%

Age disparities in stage‐specific colon cancer survival across seven countries: An International Cancer Benchmarking PartnershipSURVMARK‐2 population‐based study

Pilleron

Charvat

Araghi

et al. 2020

Intl Journal of Cancer

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“…BSC patients represented almost half of the cohort, as in a previous French field cohort study . The proportion of older adults treated with any anticancer medication did not increase during the 2009 to 2013 period, yet scientific evidence regarding the treatment of older adult cancer patients accrued during the period.…”

Section: Discussionmentioning

confidence: 62%

“…BSC patients represented almost half of the cohort, as in a previous French field cohort study. 16 The proportion of older adults treated with any anticancer medication did not increase during the 2009 to 2013 period, yet scientific evidence regarding the treatment of older adult cancer patients accrued during the period. It is unlikely that all these patients would not have benefited from conventional chemotherapy and/or targeted therapy, suggesting that physicians are still reluctant to prescribe anticancer medications for older adults.…”

Section: Discussionmentioning

confidence: 99%

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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“…Given that the concurrent use of chemotherapeutics in combination with radiotherapy improves clinical treatment outcomes for an increasing number of malignancies , the present study shows that X‐ray irradiation could affect CPT‐11 pharmacokinetics and provides a reason for considering the adjustment of chemotherapeutic administration during the radiotherapy course. The pharmacokinetics of CPT‐11 during concurrent chemoradiation therapy should be rechecked, and the optimal CPT‐11 dose should be reevaluated, and adjusted if necessary, during concurrent chemoradiation therapy.…”

Section: Discussionmentioning

confidence: 88%

Effect of X‐ray irradiation on pharmacokinetics of irinotecan hydrochloride and expression of CES1 and CYP3A1 in rats

Qiao

Wang

Xin

et al. 2019

Fundamemntal Clinical Pharma

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Concurrent chemoradiation with irinotecan hydrochloride (CPT‐11) is accepted for cancer treatment. However, the effects of X‐ray irradiation on chemotherapeutics in the plasma remain unclear. We evaluated the pharmacokinetics of CPT‐11 in rats after exposure to X‐ray irradiation and examined the changes of protein and mRNA expression of CES1 and CYP3A1. The X‐ray irradiation with 1 Gy and 5 Gy was delivered to the whole body of rats. CPT‐11 at 30 and 60 mg/kg, respectively, was intravenously infused 24 h after irradiation. CPT‐11 was determined by RP‐HPLC in plasma. ELISA and PCR were used to analyze the protein and mRNA expression of CES1 and CYP3A1, respectively. Compared with control rats, the X‐ray irradiation decreased the AUC of CPT‐11 (30 mg/kg) by 15.6% at 1 Gy and 39.0% at 5 Gy and increased the CL by 60.0% at 5 Gy. The X‐ray irradiation could also decrease the AUC of CPT‐11 (60 mg/kg) and increase the CL. In addition, the protein and mRNA expression of CES1 and CYP3A1 were increased significantly in rats after irradiation. This study found significant changes in the pharmacokinetics of CPT‐11 in rats after exposure to X‐ray irradiation, and they might be due to significant increases in the expressions of CYP3A1 and CES1. The pharmacokinetics of CPT‐11 should be rechecked, and the optimal CPT‐11 dose should be reevaluated during concurrent chemoradiation therapy.

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How are elderly patients treated after a diagnosis of metastatic colorectal cancer in real‐life practice? A study in a French teaching hospital

Cited by 6 publications

References 17 publications

Age disparities in stage‐specific colon cancer survival across seven countries: An International Cancer Benchmarking PartnershipSURVMARK‐2 population‐based study

Age disparities in stage‐specific colon cancer survival across seven countries: An International Cancer Benchmarking PartnershipSURVMARK‐2 population‐based study

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

Effect of X‐ray irradiation on pharmacokinetics of irinotecan hydrochloride and expression of CES1 and CYP3A1 in rats

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