Chuan Jie Zhao1, ShuLiang Li1, Qiang Liu2. 1. Department of Gastrointestinal Surgery, The Second People's Hospital of Liao Cheng, Liao Cheng, Shandong Province, China. 2. Department of Surgical Oncology Surgery, The First Hospital of HeBei Medical Univeristy, Shi Jia Zhuang, He Bei Province, China.
Abstract
AIM: Patients aged 65 years and older are often underrepresented in clinical trials of metastatic colorectal cancer (mCRC) and probably undertreated in clinical practice. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of molecular targeted agents (MTAs) in this population. MATERIALS AND METHODS: A comprehensive literature search for studies published up to December 2014 was performed. The endpoints were overall survival (OS) and progression-free survival (PFS). The pooled hazard ratio (HR) and 95% confidence intervals (CIs) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials. RESULTS: Eleven RCTs involving 8,488 patients were ultimately identified. The pooled analysis demonstrated that the use of MTAs in elderly patients with mCRC significantly improve OS (HR 0.84, 95% CI: 0.76-0.92, P < 0.001) and PFS (HR 0.78, 95% CI: 0.64-0.96, P = 0.017) when compared to MTAs-free therapies. Similar results of OS were observed in subgroup analysis according to treatment line, therapy regimes, and approval status of MTAs. No publication bias was detected by Begg's and Egger's tests. CONCLUSIONS: The introduction of MTAs to therapies offered a survival benefit in elderly patients with mCRC. Further studies aimed at this specific patient population were still needed to watchfully monitor potential treatment-related toxicities to optimize the use of these drugs.
AIM: Patients aged 65 years and older are often underrepresented in clinical trials of metastatic colorectal cancer (mCRC) and probably undertreated in clinical practice. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of molecular targeted agents (MTAs) in this population. MATERIALS AND METHODS: A comprehensive literature search for studies published up to December 2014 was performed. The endpoints were overall survival (OS) and progression-free survival (PFS). The pooled hazard ratio (HR) and 95% confidence intervals (CIs) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials. RESULTS: Eleven RCTs involving 8,488 patients were ultimately identified. The pooled analysis demonstrated that the use of MTAs in elderly patients with mCRC significantly improve OS (HR 0.84, 95% CI: 0.76-0.92, P < 0.001) and PFS (HR 0.78, 95% CI: 0.64-0.96, P = 0.017) when compared to MTAs-free therapies. Similar results of OS were observed in subgroup analysis according to treatment line, therapy regimes, and approval status of MTAs. No publication bias was detected by Begg's and Egger's tests. CONCLUSIONS: The introduction of MTAs to therapies offered a survival benefit in elderly patients with mCRC. Further studies aimed at this specific patient population were still needed to watchfully monitor potential treatment-related toxicities to optimize the use of these drugs.