Patterns of Use, Safety, and Effectiveness of Targeted Therapies in First-Line Treatment of Metastatic Colorectal Cancer According to Age: The STROMBOLI Cohort Study.
Age Factors
Aged
Aged, 80 and over
Antineoplastic Agents
/ administration & dosage
Bevacizumab
/ administration & dosage
Cetuximab
/ administration & dosage
Cohort Studies
Colorectal Neoplasms
/ drug therapy
Disease-Free Survival
Female
Fluorouracil
/ administration & dosage
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Molecular Targeted Therapy
Neoplasm Metastasis
Proportional Hazards Models
Survival Rate
Treatment Outcome
Aged
Colorectal neoplasm
Frail elderly
Molecular targeted therapy
Neoplasm metastasis
Journal
Clinical colorectal cancer
ISSN: 1938-0674
Titre abrégé: Clin Colorectal Cancer
Pays: United States
ID NLM: 101120693
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
17
05
2018
revised:
20
11
2018
accepted:
21
11
2018
pubmed:
12
1
2019
medline:
20
7
2019
entrez:
12
1
2019
Statut:
ppublish
Résumé
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. 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.
Sections du résumé
BACKGROUND
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.
RESULTS
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.
CONCLUSION
Despite treatment adaptations, elderly patients could benefit from targeted therapies as younger without safety warning.
Identifiants
pubmed: 30630730
pii: S1533-0028(18)30247-0
doi: 10.1016/j.clcc.2018.11.005
pii:
doi:
Substances chimiques
Antineoplastic Agents
0
Bevacizumab
2S9ZZM9Q9V
Cetuximab
PQX0D8J21J
Fluorouracil
U3P01618RT
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e150-e162Investigateurs
D Smith
(D)
N Tubiana-Mathieu
(N)
P Michel
(P)
R Guimbaud
(R)
Y Becouarn
(Y)
F Viret
(F)
R Guimbaud
(R)
D Larregain-Fournier
(D)
Y Botreau
(Y)
P Texereau
(P)
D Auby
(D)
L Gautier-Felizot
(L)
I Loury-Larivière
(I)
E Brudieux
(E)
L Cany
(L)
C Lecaille
(C)
D Jaubert
(D)
P Guichard
(P)
O Bernard
(O)
L Vives
(L)
N Taoubi
(N)
M Martinez
(M)
F Burki
(F)
I Roque
(I)
F Thouveny
(F)
M H Gaspard
(MH)
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.