TY - JOUR
T1 - Management of metastatic colorectal cancer in patients ≥70 years - a single center experience.
AU - Huemer, Florian
AU - Dunkl, Celine
AU - Rinnerthaler, Gabriel
AU - Schlick, Konstantin
AU - Heregger, Ronald
AU - Emmanuel, Klaus
AU - Neureiter, Daniel
AU - Klieser, Eckhard
AU - Deutschmann, Michael
AU - Roeder, Falk
AU - Greil, Richard
AU - Weiss, Lukas
N1 - Huemer, Dunkl, Rinnerthaler, Schlick, Heregger, Greil, Weiss: Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria; Emmanuel: Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria; Neureiter, Klieser: Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; Deutschmann: Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria; Roeder: Department of Radiation Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria
PY - 2023/7/25
Y1 - 2023/7/25
N2 - BackgroundAge-standardized mortality rates for metastatic colorectal cancer (mCRC) are highest among elderly patients. In current clinical guidelines, treatment recommendations for this patient population are based on a limited number of clinical trials. Patients and methodsIn this monocentric, retrospective analysis we characterized patients aged & GE;70 years undergoing systemic therapy for mCRC and overall survival (OS) was investigated. ResultsWe included 117 unselected, consecutive mCRC patients aged & GE;70 years undergoing systemic therapy for mCRC between February 2009 and July 2022. Median OS was 25.6 months (95% CI: 21.8-29.4). The median age was 78 years (range: 70-90) and 21%, 48%, 26% and 5% had an ECOG performance score of 0, 1, 2, and 3, respectively. The median number of systemic therapy lines was 2 (range: 1-5). The choice of first-line chemotherapy backbone (doublet/triplet versus mono) did not impact OS (HR: 0.83, p=0.50) or the probability of receiving subsequent therapy (p=0.697). Metastasectomy and/or local ablative treatment in the liver, lung, peritoneum and/or other organs were applied in 26 patients (22%) with curative intent. First-line anti-EGFR-based therapy showed a trend towards longer OS compared to anti-VEGF-based therapy or chemotherapy alone in left-sided mCRC (anti-EGFR: 39.3 months versus anti-VEGF: 27.3 months versus chemotherapy alone: 13.8 months, p=0.105). In multivariable analysis, metastasectomy and/or local ablative treatment with curative intent (yes versus no, HR: 0.22, p<0.001), the ECOG performance score (2 versus 0, HR: 3.07, p=0.007; 3 versus 0, HR: 3.66, p=0.053) and the presence of liver metastases (yes versus no, HR: 1.79, p=0.049) were independently associated with OS. ConclusionsOur findings corroborate front-line monochemotherapy in combination with targeted therapy as the treatment of choice for elderly mCRC patients with palliative treatment intent. Metastasectomy and/or local ablative treatment with curative intent are feasible and may improve OS in selected elderly mCRC patients.
AB - BackgroundAge-standardized mortality rates for metastatic colorectal cancer (mCRC) are highest among elderly patients. In current clinical guidelines, treatment recommendations for this patient population are based on a limited number of clinical trials. Patients and methodsIn this monocentric, retrospective analysis we characterized patients aged & GE;70 years undergoing systemic therapy for mCRC and overall survival (OS) was investigated. ResultsWe included 117 unselected, consecutive mCRC patients aged & GE;70 years undergoing systemic therapy for mCRC between February 2009 and July 2022. Median OS was 25.6 months (95% CI: 21.8-29.4). The median age was 78 years (range: 70-90) and 21%, 48%, 26% and 5% had an ECOG performance score of 0, 1, 2, and 3, respectively. The median number of systemic therapy lines was 2 (range: 1-5). The choice of first-line chemotherapy backbone (doublet/triplet versus mono) did not impact OS (HR: 0.83, p=0.50) or the probability of receiving subsequent therapy (p=0.697). Metastasectomy and/or local ablative treatment in the liver, lung, peritoneum and/or other organs were applied in 26 patients (22%) with curative intent. First-line anti-EGFR-based therapy showed a trend towards longer OS compared to anti-VEGF-based therapy or chemotherapy alone in left-sided mCRC (anti-EGFR: 39.3 months versus anti-VEGF: 27.3 months versus chemotherapy alone: 13.8 months, p=0.105). In multivariable analysis, metastasectomy and/or local ablative treatment with curative intent (yes versus no, HR: 0.22, p<0.001), the ECOG performance score (2 versus 0, HR: 3.07, p=0.007; 3 versus 0, HR: 3.66, p=0.053) and the presence of liver metastases (yes versus no, HR: 1.79, p=0.049) were independently associated with OS. ConclusionsOur findings corroborate front-line monochemotherapy in combination with targeted therapy as the treatment of choice for elderly mCRC patients with palliative treatment intent. Metastasectomy and/or local ablative treatment with curative intent are feasible and may improve OS in selected elderly mCRC patients.
KW - FOLFOXIRI PLUS BEVACIZUMAB
KW - OPEN-LABEL
KW - ELDERLY-PATIENTS
KW - OLDER PATIENTS
KW - 1ST-LINE TREATMENT
KW - LIVER METASTASES
KW - PHASE-3
KW - MULTICENTER
KW - COMORBIDITY
KW - SURVIVAL
U2 - 10.3389/fonc.2023.1222951
DO - 10.3389/fonc.2023.1222951
M3 - Original Article
C2 - 37560467
SN - 2234-943X
VL - 13
SP - 1222951
JO - FRONTIERS IN ONCOLOGY
JF - FRONTIERS IN ONCOLOGY
M1 - 1222951
ER -