Management of metastatic colorectal cancer in patients ≥70 years - a single center experience

Frontiers in Oncology

Oncology

Daniel Neureiter¹  Konstantin Schlick²  Florian Huemer²  Celine Dunkl²  Ronald Heregger²  Gabriel Rinnerthaler³  Lukas Weiss⁴  Richard Greil⁴  Falk Roeder⁵  Michael Deutschmann⁶  Klaus Emmanuel⁷  Eckhard Klieser⁸ 

[1] Cancer Cluster Salzburg, Salzburg, Austria;Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria;Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria;Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria;Cancer Cluster Salzburg, Salzburg, Austria;Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria;Cancer Cluster Salzburg, Salzburg, Austria;Tumor Registry of the Province of Salzburg, Salzburg, Austria;Department of Radiation Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria;Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria;Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria;Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria;

关键词: elderly;    age;    ECOG performance score;    colorectal cancer;    sidedness;    local ablative treatment;    metastasectomy;   

DOI  :  10.3389/fonc.2023.1222951

 received in 2023-05-22, accepted in 2023-06-23,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundAge-standardized mortality rates for metastatic colorectal cancer (mCRC) are highest among elderly patients. In current clinical guidelines, treatment recommendations for this patient population are based on a limited number of clinical trials.Patients and methodsIn this monocentric, retrospective analysis we characterized patients aged ≥70 years undergoing systemic therapy for mCRC and overall survival (OS) was investigated.ResultsWe included 117 unselected, consecutive mCRC patients aged ≥70 years undergoing systemic therapy for mCRC between February 2009 and July 2022. Median OS was 25.6 months (95% CI: 21.8-29.4). The median age was 78 years (range: 70-90) and 21%, 48%, 26% and 5% had an ECOG performance score of 0, 1, 2, and 3, respectively. The median number of systemic therapy lines was 2 (range: 1-5). The choice of first-line chemotherapy backbone (doublet/triplet versus mono) did not impact OS (HR: 0.83, p=0.50) or the probability of receiving subsequent therapy (p=0.697). Metastasectomy and/or local ablative treatment in the liver, lung, peritoneum and/or other organs were applied in 26 patients (22%) with curative intent. First-line anti-EGFR-based therapy showed a trend towards longer OS compared to anti-VEGF-based therapy or chemotherapy alone in left-sided mCRC (anti-EGFR: 39.3 months versus anti-VEGF: 27.3 months versus chemotherapy alone: 13.8 months, p=0.105). In multivariable analysis, metastasectomy and/or local ablative treatment with curative intent (yes versus no, HR: 0.22, p<0.001), the ECOG performance score (2 versus 0, HR: 3.07, p=0.007; 3 versus 0, HR: 3.66, p=0.053) and the presence of liver metastases (yes versus no, HR: 1.79, p=0.049) were independently associated with OS.ConclusionsOur findings corroborate front-line monochemotherapy in combination with targeted therapy as the treatment of choice for elderly mCRC patients with palliative treatment intent. Metastasectomy and/or local ablative treatment with curative intent are feasible and may improve OS in selected elderly mCRC patients.

【 授权许可】

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Copyright © 2023 Huemer, Dunkl, Rinnerthaler, Schlick, Heregger, Emmanuel, Neureiter, Klieser, Deutschmann, Roeder, Greil and Weiss