Thomas Aparicio1, Dany Gargot2, Laurent Teillet3, Emilie Maillard4, Dominique Genet5, Jacques Cretin6, Christophe Locher7, Olivier Bouché8, Gilles Breysacher9, Jean-François Seitz10, Mohamed Gasmi11, Laetitia Stefani12, Mohamed Ramdani13, Thierry Lecomte14, Dominique Auby15, Roger Faroux16, Jean-Baptiste Bachet17, Céline Lepère18, Faiza Khemissa19, Iradj Sobhani20, Olivier Boulat21, Emmanuel Mitry22, Jean-Louis Jouve23. 1. Gastroenterology Department, CHU Saint Louis, APHP, Université Paris 7, Sorbonne Paris Cité, Paris, France. Electronic address: thomas.aparicio@aphp.fr. 2. Gastroenterology Department, CH Blois, Blois, France. Electronic address: dgargot@ch-blois.fr. 3. Geriatric Department, CHU Sainte Perine, APHP, Versailles Saint-Quentin University, Paris, France. Electronic address: laurent.teillet@aphp.fr. 4. Statistics Department, Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France. Electronic address: emilie.maillard@u-bourgogne.fr. 5. Oncology Department, Clinique Chénieux, Limoges, France. 6. CH Oncogard, Alès, France. Electronic address: cretinjacques@yahoo.fr. 7. Gastroenterology Department, CH Meaux, Meaux, France. Electronic address: c-locher@ch-meaux.fr. 8. Gastroenterology Department, CHU Robert Debré, Reims, France. Electronic address: obouche@chu-reims.fr. 9. Gastroenterology Department, CH Pasteur, Colmar, France. Electronic address: gilles.breysacher@ch-colmar.fr. 10. Digestive Oncology and Gastroenterology Department, CHU La Timone, APHM, Aix-Marseille University, Marseille, France. Electronic address: Jean-francois.seitz@ap-hm.fr. 11. Gastroenterology Department, CHU Hôpital Nord, Marseille, France. Electronic address: mohamed.gasmi@ap-hm.fr. 12. Oncology Department, CH Annecy Genevois, Pringy, France. Electronic address: lstefani@ch-annecygenevois.fr. 13. Gastroenterology Department, CH Béziers, Béziers, France. Electronic address: mohamed.ramdani@ch-beziers.fr. 14. Gastroenterology Department, CHU Trousseau, Tours, France. Electronic address: thierry.lecomte@univ-tours.fr. 15. Gastroenterology Department, CH de Mont de Marsan, Mont de Marsan, France. Electronic address: dominique.auby@ch-mt-marsan.fr. 16. Gastroenterology Department, CH de la Roche sur Yon, La Roche sur Yon, France. Electronic address: roger.faroux@chd-vendee.fr. 17. Sorbonne University, UPMC Gastroenterology Department, CHU Pitié-Salpétrière, APHP, Paris, France. Electronic address: jean-baptiste.bachet@psl.aphp.fr. 18. Gastroenterology Department, CHU Ambroise Paré, APHP, Boulogne, France. Electronic address: celine.lepere@egp.aphp.fr. 19. Gastroenterology Department, CH Saint Jean, Perpignan, France. Electronic address: faiza.khemissa@ch-perpignan.fr. 20. Gastroenterology Department, CHU Henri Mondor, APHP, Créteil, France. Electronic address: iradj.sobhani@aphp.fr. 21. Oncology Department, CH Avignon, Avignon, France. Electronic address: OBoulat@ch-avignon.fr. 22. Oncology Department, Institut Curie, Saint-Cloud, France. Electronic address: emmanuel.mitry@uvsq.fr. 23. CHU Le Bocage and INSERM U866 Dijon, France. Electronic address: jean-louis.jouve@chu-dijon.fr.
Abstract
AIM: Several predictors of metastatic colorectal cancer (mCRC) outcomes have been described. Specific geriatric characteristics could be of interest to determine prognosis. METHOD:Elderly patients (75+) with previously untreated mCRC were randomly assigned to receive infusional 5-fluorouracil-based chemotherapy, either alone (FU) or in combination with irinotecan (IRI). Geriatric evaluations were included as an optional procedure. The predictive value of geriatric parameters was determined for the objective response rate (ORR), progression-free survival (PFS) and overall survival (OS). RESULTS:From June 2003 to May 2010, the FFCD 2001-02 randomised trial enrolled 282 patients. A baseline geriatric evaluation was done in 123 patients; 62 allocated to the FU arm and 61 to the IRI arm. The baseline Charlson index was ≤1 in 75%, Mini-Mental State Examination was ≤27/30 in 31%, Geriatric Depression Scale was >2 in 10% and Instrumental Activities of Daily Living (IADL) was impaired in 34% of the patients. Multivariate analyses revealed that no geriatric parameter was predictive for ORR or PFS. Normal IADL was independently associated with better OS. The benefit of doublet chemotherapy on PFS differed in subgroups of patients ≤80 years, with unresected primary tumour, leucocytes >11,000 mm3 and carcinoembryonic antigen >2N. There was a trend towards better OS in patients with normal IADL. CONCLUSION: The autonomy score was an independent predictor for OS. A trend toward a better efficacy of doublet chemotherapy in some subgroups of patients was reported and should be further explored.
RCT Entities:
AIM: Several predictors of metastatic colorectal cancer (mCRC) outcomes have been described. Specific geriatric characteristics could be of interest to determine prognosis. METHOD: Elderly patients (75+) with previously untreated mCRC were randomly assigned to receive infusional 5-fluorouracil-based chemotherapy, either alone (FU) or in combination with irinotecan (IRI). Geriatric evaluations were included as an optional procedure. The predictive value of geriatric parameters was determined for the objective response rate (ORR), progression-free survival (PFS) and overall survival (OS). RESULTS: From June 2003 to May 2010, the FFCD 2001-02 randomised trial enrolled 282 patients. A baseline geriatric evaluation was done in 123 patients; 62 allocated to the FU arm and 61 to the IRI arm. The baseline Charlson index was ≤1 in 75%, Mini-Mental State Examination was ≤27/30 in 31%, Geriatric Depression Scale was >2 in 10% and Instrumental Activities of Daily Living (IADL) was impaired in 34% of the patients. Multivariate analyses revealed that no geriatric parameter was predictive for ORR or PFS. Normal IADL was independently associated with better OS. The benefit of doublet chemotherapy on PFS differed in subgroups of patients ≤80 years, with unresected primary tumour, leucocytes >11,000 mm3 and carcinoembryonic antigen >2N. There was a trend towards better OS in patients with normal IADL. CONCLUSION: The autonomy score was an independent predictor for OS. A trend toward a better efficacy of doublet chemotherapy in some subgroups of patients was reported and should be further explored.
Authors: Supriya G Mohile; William Dale; Mark R Somerfield; Mara A Schonberg; Cynthia M Boyd; Peggy S Burhenn; Beverly Canin; Harvey Jay Cohen; Holly M Holmes; Judith O Hopkins; Michelle C Janelsins; Alok A Khorana; Heidi D Klepin; Stuart M Lichtman; Karen M Mustian; William P Tew; Arti Hurria Journal: J Clin Oncol Date: 2018-05-21 Impact factor: 44.544
Authors: T Aparicio; O Bouché; J Taieb; E Maillard; S Kirscher; P-L Etienne; R Faroux; F Khemissa Akouz; F El Hajbi; C Locher; Y Rinaldi; T Lecomte; S Lavau-Denes; M Baconnier; A Oden-Gangloff; D Genet; E Paillaud; F Retornaz; E François; L Bedenne Journal: Ann Oncol Date: 2018-01-01 Impact factor: 32.976