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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References
- Cancer Statistics, 2017.CA Cancer J Clin. 2017; 67: 7-30
- Cancer in Australia: an overview 2014. Cancer series no. 90.2014 (CAN 88, Available at: https://www.aihw.gov.au/reports/cancer/cancer-in-australia-an-overview-2014/data, Accessed: December 2017)
- Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses.J Clin Oncol. 2011; 29: 3768-3774
Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence - SEER 9 Regs Research Data, Nov 2016 Sub (1973-2014), Available at: https://seer.cancer.gov/csr/1975_2015/, Accessed: December 2017.
- Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2013; 24: vi64-vi72
- Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07.J Clin Oncol. 2007; 25: 2198-2204
- Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial.J Clin Oncol. 2009; 27: 3109-3116
- Capecitabine plus oxaliplatin compared with fluorouracil/folinic acid as adjuvant therapy for stage III colon cancer: final results of the NO16968 randomized controlled phase III trial.J Clin Oncol. 2015; 33: 3733-3740
- A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients.N Engl J Med. 2001; 345: 1091-1097
- Impact of age on the efficacy of newer adjuvant therapies in patients with stage II/III colon cancer: findings from the ACCENT database.J Clin Oncol. 2013; 31: 2600-2606
- Impact of age and medical comorbidity on adjuvant treatment outcomes for stage III colon cancer: a pooled analysis of individual patient data from four randomized, controlled trials.Ann Oncol. 2015; 26: 715-724
- Comparative effectiveness of oxaliplatin vs non-oxaliplatin-containing adjuvant chemotherapy for stage III colon cancer.J Natl Cancer Inst. 2012; 104: 211-227
- Effect of adjuvant chemotherapy on survival of patients with stage III colon cancer diagnosed after age 75 years.J Clin Oncol. 2012; 30: 2624-2634
- Efficacy and safety of single agent or combination adjuvant chemotherapy in elderly patients with colon cancer: a Canadian cancer institute experience.Clin Colorectal Cancer. 2014; 13: 199-206
- Comparative effectiveness of 5-fluorouracil with and without oxaliplatin in the treatment of colorectal cancer in clinical practice.Anticancer Res. 2013; 33: 1053-1060
- Oral single-agent chemotherapy in older patients with solid tumours: a position paper from the International Society of Geriatric Oncology (SIOG).Eur J Cancer. 2015; 51: 2491-2500
- Fritz A. Percy C. Jack A. International classification of disease for oncology. World Health Organization, Geneva2000
- Linkage of routinely collected data in practice: the Centre for Health Record Linkage.Public Health Res Pract. 2015; 25: e2541548
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality.J Clin Epidemiol. 2004; 57: 1288-1294
- The disease and economic burden of neutropenic fever in adult patients in Australian cancer treatment centres 2008: analysis of the Victorian Admitted Episodes Dataset.Int Med J. 2011; 41: 121-129
- Adjuvant therapy with fluorouracil and oxaliplatin in stage II and elderly patients (between ages 70 and 75 years) with colon cancer: subgroup analyses of the Multicenter International Study of Oxaliplatin, Fluorouracil, and Leucovorin in the Adjuvant Treatment of Colon Cancer trial.J Clin Oncol. 2012; 30: 3353-3360
- Estimating the adjuvant chemotherapy effect in elderly stage II and III colon cancer patients in an observational study.J Surg Oncol. 2013; 107: 613-618
- Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care.J Gerontol A Biol Sci Med Sci. 2004; 59: 255-263
- Age and adjuvant chemotherapy use after surgery for stage III colon cancer.J Natl Cancer Inst. 2001; 93: 850-857
- The course of neuropathic symptoms in relation to adjuvant chemotherapy among elderly patients with stage III colon cancer: a longitudinal study.Clin Colorectal Cancer. 2017; 16: 195-203
- Chronological age and risk of chemotherapy nonfeasibility: a real-life cohort study of 153 stage II or III colorectal cancer patients given adjuvant-modified FOLFOX6.Am J Clin Oncol. 2018; 41: 73-80
- Reasons for underuse of adjuvant chemotherapy in elderly patients with stage III colon cancer.Clin Colorectal Cancer. 2016; 15: 179-185
- Prospective pooled analysis of six phase III trials investigating duration of adjuvant (adjuv) oxaliplatin-based therapy (3 vs 6 months) for patients (pts) with stage III colon cancer (CC): the IDEA (International Duration Evaluation of Adjuvant chemotherapy) collaboration.J Clin Oncol. 2017; 35 (abstract LBA1)
- Chemotherapy dosing strategies in the obese, elderly, and thin patient: results of a nationwide survey.J Oncol Pract. 2008; 4: 108-113
Article Info
Publication History
Published online: May 11, 2018
Accepted:
May 5,
2018
Received in revised form:
April 29,
2018
Received:
February 27,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
