Background: CRC pts have a median age of incidence > 65y although they are largely under-represented in phase III trials. This large population contains pts unfit for T, those suitable for monotherapy or for doublets and the impact of chemotherapy (CHT) outside clinical trial is unclear. Aim of the study was to retrospectively analyse T of elderly mCRC pts. Methods: Kaplan-Meir method was used for OS, the log-rank or Tarone-Ware test for differences between subgroups, Cox’s proportional hazard model to assess the impact of known prognostic factors and T. Results: 751 pts with mCRC observed from January 2000 to January 2013 were collected. Median age was 79y (75-93);<80y 58.1%, 80-84y 32.1%, ≥84y 9.2%; M/F 61/39%, ECOG PS:0-1/2-3 85/15%, colon/rectum 74/26%; multiple metastatic sites 34%, only liver 41% of pts. KRAS status was studied in 35% of pts with 44% mutated (M); 20,5% of pts were untreated including surgery (33% of pts ≥80y). Comorbidities: cardiovascular 34%, diabetes 14%, hypertension 50%. Primary tumor was resected in 80.6%; surgery(S) of liver metastasis in 19% of pts (2.3% of pts ≥80y). 78 % of pts underwent CHT (target therapy for 25% of pts). Median follow up was 12 months (m) (range 1-124). Median OS was 17 m (CI 95%15-19); mOS in no-treated pts was 5 m (4-6); mOS of pts with at least one T was 20 m (18-22). In KRAS M group mOS was 19 m (15-23) while in KRAS wild type pts mOS was 25m (20-30). At multivariate analysis sex (female), age (<80y), PS (0-1), CHT, S of metastasis, S of primary tumor, and Site of metastasis (liver) were prognostic factors for OS. Conclusions: These data show that in clinical practice treatment has a positive effect on elderly pts OS, confirmed at multivariate analysis. KRAS analyses deserve further evaluation. Update results will be presented. Variables HR (CI95%) P value Sex 1.21(1.01-1.46) 0.04 Age 1.75(1.45-2.12) <0.0001 ECOG PS 2.51(1.94-3.25) <0.0001 CT 2.14(1.68-2.73) <0.0001 S of metastasis 2.48(1.88-3.29) <0.0001 S of primary tumor 1.66(1.31-2.11) <0.0001

Treatment (T) of metastatic colorectal cancer (mCRC) patients (pts)≥ 75 years (y) old in clinical practice: A multicenter analysis.

Clara Natoli;
2014

Abstract

Background: CRC pts have a median age of incidence > 65y although they are largely under-represented in phase III trials. This large population contains pts unfit for T, those suitable for monotherapy or for doublets and the impact of chemotherapy (CHT) outside clinical trial is unclear. Aim of the study was to retrospectively analyse T of elderly mCRC pts. Methods: Kaplan-Meir method was used for OS, the log-rank or Tarone-Ware test for differences between subgroups, Cox’s proportional hazard model to assess the impact of known prognostic factors and T. Results: 751 pts with mCRC observed from January 2000 to January 2013 were collected. Median age was 79y (75-93);<80y 58.1%, 80-84y 32.1%, ≥84y 9.2%; M/F 61/39%, ECOG PS:0-1/2-3 85/15%, colon/rectum 74/26%; multiple metastatic sites 34%, only liver 41% of pts. KRAS status was studied in 35% of pts with 44% mutated (M); 20,5% of pts were untreated including surgery (33% of pts ≥80y). Comorbidities: cardiovascular 34%, diabetes 14%, hypertension 50%. Primary tumor was resected in 80.6%; surgery(S) of liver metastasis in 19% of pts (2.3% of pts ≥80y). 78 % of pts underwent CHT (target therapy for 25% of pts). Median follow up was 12 months (m) (range 1-124). Median OS was 17 m (CI 95%15-19); mOS in no-treated pts was 5 m (4-6); mOS of pts with at least one T was 20 m (18-22). In KRAS M group mOS was 19 m (15-23) while in KRAS wild type pts mOS was 25m (20-30). At multivariate analysis sex (female), age (<80y), PS (0-1), CHT, S of metastasis, S of primary tumor, and Site of metastasis (liver) were prognostic factors for OS. Conclusions: These data show that in clinical practice treatment has a positive effect on elderly pts OS, confirmed at multivariate analysis. KRAS analyses deserve further evaluation. Update results will be presented. Variables HR (CI95%) P value Sex 1.21(1.01-1.46) 0.04 Age 1.75(1.45-2.12) <0.0001 ECOG PS 2.51(1.94-3.25) <0.0001 CT 2.14(1.68-2.73) <0.0001 S of metastasis 2.48(1.88-3.29) <0.0001 S of primary tumor 1.66(1.31-2.11) <0.0001
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11564/699406
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