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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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.
