Cecilia M Lund1,2, Kirsten K Vistisen2, Christian Dehlendorff3, Finn Rønholt1, Julia S Johansen1,2,4, Dorte L Nielsen2,4. 1. a Department of Medicine , Herlev and Gentofte Hospital, Copenhagen University Hospital , Herlev , Denmark. 2. b Department of Oncology , Herlev and Gentofte Hospital, Copenhagen University Hospital , Herlev , Denmark. 3. c Department of Statistics and Pharmacoepidemiology , Danish Cancer Society Research Center, Danish Cancer Society , Copenhagen , Denmark. 4. d Department of Clinical Medicine , Faculty of Health and Medical Sciences, University of Copenhagen , Denmark.
Abstract
OBJECTIVES: First-line chemotherapy for metastatic colorectal cancer (mCRC) is effective and feasible in selected older patients. We investigated age-dependent differences in treatment and outcomes in patients with mCRC in clinical practice. MATERIAL AND METHODS: A retrospective study of 654 patients with mCRC referred to first-line chemotherapy in 2008-2014. Patients were divided into two age groups: 50-69 and ≥70 (older patients). Binary outcomes were analyzed by logistic regression. Progression-free survival (PFS) and overall survival (OS) were analyzed by Cox proportional hazards regression, CRC-specific and other-cause mortality with Fine and Gray proportional hazard model for the sub-distribution of a competing risk. RESULTS: After adjusting for performance status (PS) and comorbidity, older patients were more likely to receive monotherapy (adjusted odds ratio (aOR) = 9.00, 95% confidence interval (CI) 4.52-17.91), lower doses, and no additional targeted therapy (aOR = 1.89, 95% CI 1.28-2.78) than younger patients. Yet, older patients experienced more toxicity and hospitalizations (aOR = 1.53, 95% CI 1.08-2.17). Among those treated, older patients had shorter PFS (hazard ratio (HR) = 1.32, 95% CI 1.11-1.57), but after adjusting for PS and comorbidity, PFS was similar. No significant difference was found in CRC mortality (HR = 1.15, 95% CI 0.95-1.40) between age groups. Poor PS was associated with shorter OS and PFS and higher CRC mortality. CONCLUSIONS: In the DISCO study, older patients with mCRC received less aggressive first-line chemotherapy. Yet, they experienced more toxicity. Younger and older patients had similar CRC mortality. Shorter PFS and higher CRC mortality were observed in patients with poor PS.
OBJECTIVES: First-line chemotherapy for metastatic colorectal cancer (mCRC) is effective and feasible in selected older patients. We investigated age-dependent differences in treatment and outcomes in patients with mCRC in clinical practice. MATERIAL AND METHODS: A retrospective study of 654 patients with mCRC referred to first-line chemotherapy in 2008-2014. Patients were divided into two age groups: 50-69 and ≥70 (older patients). Binary outcomes were analyzed by logistic regression. Progression-free survival (PFS) and overall survival (OS) were analyzed by Cox proportional hazards regression, CRC-specific and other-cause mortality with Fine and Gray proportional hazard model for the sub-distribution of a competing risk. RESULTS: After adjusting for performance status (PS) and comorbidity, older patients were more likely to receive monotherapy (adjusted odds ratio (aOR) = 9.00, 95% confidence interval (CI) 4.52-17.91), lower doses, and no additional targeted therapy (aOR = 1.89, 95% CI 1.28-2.78) than younger patients. Yet, older patients experienced more toxicity and hospitalizations (aOR = 1.53, 95% CI 1.08-2.17). Among those treated, older patients had shorter PFS (hazard ratio (HR) = 1.32, 95% CI 1.11-1.57), but after adjusting for PS and comorbidity, PFS was similar. No significant difference was found in CRC mortality (HR = 1.15, 95% CI 0.95-1.40) between age groups. Poor PS was associated with shorter OS and PFS and higher CRC mortality. CONCLUSIONS: In the DISCO study, older patients with mCRC received less aggressive first-line chemotherapy. Yet, they experienced more toxicity. Younger and older patients had similar CRC mortality. Shorter PFS and higher CRC mortality were observed in patients with poor PS.
Authors: Dora Niedersüß-Beke; Manuel Orlinger; David Falch; Cordula Heiler; Gudrun Piringer; Josef Thaler; Wolfgang Hilbe; Andreas Petzer; Holger Rumpold Journal: Cancers (Basel) Date: 2021-04-26 Impact factor: 6.639
Authors: Kah Poh Loh; Vivian Lam; Katey Webber; Simran Padam; Mina S Sedrak; Vivek Musinipally; Madison Grogan; Carolyn J Presley; Janice Grandi; Chandrika Sanapala; Daniel A Castillo; Grace DiGiovanni; Supriya G Mohile; Louise C Walter; Melisa L Wong Journal: J Natl Compr Canc Netw Date: 2021-04-15 Impact factor: 12.693