Patterns of use, safety and effectiveness of targeted therapies in first-line treatment of metastatic colorectal cancer according to age: the STROMBOLI cohort study.
Clinical colorectal cancer, Mar 2019
- Gouverneur, J. Coutureau, J. Jové, M. Rouyer, A. Grelaud, S. Duc, S. Gérard, D. Smith, A. Ravaud, C. Droz, M-A. Bernard, R. Lassalle, A. Fourrier-Réglat, P. Noize, on behalf the ETNA study group and the EREBUS study group
Metastatic colorectal cancer (mCRC) is increasingly treated using targeted therapies. Their real-life evaluation is insufficient, especially in elderly and frail patients. The aim was to describe use, safety, and effectiveness of targeted therapies in first-line mCRC treatment according to age.
PATIENTS AND METHODS :
Two field cohorts of patients initiating bevacizumab or cetuximab for first-line mCRC were pooled. Patients characteristics, use, and safety were compared between younger and elderly patients (<75 vs. ≥75 years). Two-year overall survival (OS) and progression-free survival (PFS) were estimated in both age groups using the Kaplan-Meier method adjusted on factors associated with death or progression identified with Cox multivariate modeling.
Eight hundred patients (n = 411, 51.4% bevacizumab) were included: 498 (62.3%) male, median age 64 years, 118 (14.8%) Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥2. Elderly patients (n = 126, 15.8%) were more often treated with 5-fluorouracil alone than younger. Severe adverse events were equivalent across age groups. ECOG-PS ≥1, abnormal hemoglobin, and abnormal alkaline phosphatases were associated with a higher risk of death; OS adjusted on these factors was similar between elderly and younger patients. ECOG-PS ≥1, lung metastases, abnormal hemoglobin, and abnormal creatinine clearance were associated with a higher risk of progression or death; PFS adjusted on these factors was similar across groups.
Despite treatment adaptations, elderly patients could benefit from targeted therapies as younger without safety warning.
Copyright © 2018 Elsevier Inc. All rights reserved.
Aged; Colorectal neoplasm; Frail elderly; Molecular targeted therapy; Neoplasm metastasis