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Safety and Efficacy of Oxaliplatin Doublet Adjuvant Chemotherapy in Elderly Patients With Stage III Colon Cancer

  • Daniel Brungs
    Correspondence
    Address for correspondence: Daniel Brungs, BMedSci, MBBS, MMed, FRACP, Illawarra Cancer Care Centre, Wollongong Hospital, Crown St, Wollongong 2500, Australia
    Affiliations
    Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia

    School of Biological Sciences, University of Wollongong, Wollongong, Australia

    Illawarra Cancer Centre, Wollongong Hospital, Wollongong, Australia

    CONCERT – Centre for Oncology Education and Research Translation, New South Wales, Australia
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  • Morteza Aghmesheh
    Affiliations
    Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia

    Illawarra Cancer Centre, Wollongong Hospital, Wollongong, Australia

    CONCERT – Centre for Oncology Education and Research Translation, New South Wales, Australia
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  • Paul de Souza
    Affiliations
    CONCERT – Centre for Oncology Education and Research Translation, New South Wales, Australia

    Medical Oncology Department, Liverpool Hospital, Sydney, Australia

    Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, Australia

    School of Medicine, Western Sydney University, Sydney, Australia

    South Western Medical School, University of New South Wales, Sydney, Australia
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  • Martin Carolan
    Affiliations
    Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia

    Illawarra Cancer Centre, Wollongong Hospital, Wollongong, Australia

    CONCERT – Centre for Oncology Education and Research Translation, New South Wales, Australia
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  • Philip Clingan
    Affiliations
    Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia

    Illawarra Cancer Centre, Wollongong Hospital, Wollongong, Australia
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  • June Rose
    Affiliations
    Illawarra Cancer Centre, Wollongong Hospital, Wollongong, Australia
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  • Marie Ranson
    Affiliations
    Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia

    School of Biological Sciences, University of Wollongong, Wollongong, Australia

    CONCERT – Centre for Oncology Education and Research Translation, New South Wales, Australia
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      Abstract

      Background

      Colon cancer is common in the elderly, but owing to under representation in clinical trials, the benefit of standard therapies is uncertain in this age group. We aimed to clarify the efficacy and complications of adjuvant oxaliplatin and fluoropyrimidine chemotherapy for patients 70 years and older with stage III colon cancer.

      Patients and Methods

      All patients with stage III colon adenocarcinoma were identified from an Australian cancer registry (2006-2013). Multivariable Cox hazard regression was used to determine prognostic factors for all-cause mortality. Chemotherapy complications were quantified using discontinuation rates, hospital admissions, and mortality for 12 months after starting chemotherapy.

      Results

      A total of 2164 patients fulfilled our inclusion criteria, including 1080 (49.9%) patients ≥ 70 years. Patients ≥ 70 years were less likely to receive adjuvant chemotherapy (60.7% vs. 89.6%) or oxaliplatin doublet chemotherapy (18.8% vs. 71.2%). Older patients receiving oxaliplatin were more likely to cease treatment early (18.7% vs. 7.6%) and require hospital admission (67.0% vs. 53.5%). The addition of oxaliplatin provided an overall survival benefit for patients < 70 years (hazard ratio, 0.44; 95% confidence interval, 0.3-0.6; P < .0001) and for patients ≥ 70 years (hazard ratio, 0.64; 95% confidence interval, 0.5-0.9; P = .005).

      Conclusions

      Despite a modestly increased rate of hospital admission and early chemotherapy cessation, we demonstrate a persistent survival benefit for the addition of oxaliplatin to a fluoropyrimidine as adjuvant treatment for stage III colon cancer in elderly patients.

      Keywords

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