Chemotherapy in the Metastatic Setting
Balancing between the competing risks of tumor death and toxicity with the influence of comorbidity and ageing on both, prognosis and treatment tolerability are essential for treatment decisions in elderly patients.
For patients enrolled in clinical trials, meta-analyses have shown an efficacy of chemotherapy in elderly patients similar to younger patients and no major differences in treatment effect. Nonrandomized phase II trials in elderly patients demonstrated similar results with chemotherapy as for younger patients. These analyses have therefore the methodological problem that the age distribution in clinical trials does not reflect daily clinical practice and that only a subset of elderly patients participated in the trials. The British FOCUS 2 enrolling frail patients demonstrated a better “overall treatment utility” if patients were treated with combination chemotherapy instead of fluoropyrimidine monotherapy.
KeywordsMetastatic colorectal cancer Elderly patients Chemotherapy 5-FU Fluoropyrimidine Oxaliplatin Irinotecan Comorbidity Stage IV metastases Palliative chemotherapy
- 1.Van Cutsem E, Tabernero J, Lakomy R, et al. Intravenous (iv) aflibercept versus placebo in combination with irinotecan/5-fu (FOLFIRI) for second-line treatment of metastatic colorectal cancer (mCRC): results of a multinational phase III trial (EFC10262-VELOUR). Ann Oncol. 2011;22(5s; abstr O-0024).Google Scholar
- 2.Grothey A, Sobrero A, Siena S, et al. Results of a phase III randomized, double-blind, placebo-controlled, multicenter trial (CORRECT) of regorafenib plus best supportive care (BSC) versus placebo plus BSC in patients (pts) with metastatic colorectal cancer (mCRC) who have progressed after standard therapies. J Clin Oncol. 2012; 30(suppl 4; abstr LBA385).Google Scholar
- 8.Chau I, Norman AR, Cunningham D, et al. Elderly patients with fluoropyrimidine and thymidylate synthase inhibitor-resistant advanced colorectal cancer derive similar benefit without excessive toxicity when treated with irinotecan monotherapy. Br J Cancer. 2004;91(8):1453–8.PubMedCrossRefGoogle Scholar
- 10.Mitry E, Phelip F, Bonnetain F, et al. Phase III trial of chemotherapy with or without irinotecan in the front-line treatment of metastatic colorectal cancer in elderly patients (FFCD 2001–02 trial): results of a planned interim analysis. In: Proceedings of gastrointestinal cancer symposium (ASCO/AGA/ASTRO/SSO). 2008. Abstract 281.Google Scholar
- 14.Sargent DJ, Kohne CH, Sanoff HK, et al. Pooled safety and efficacy analysis examining the effect of performance status on outcomes in nine first-line treatment trials using individual data from patients with metastatic colorectal cancer. J Clin Oncol. 2009;27(12):1948–55.PubMedCrossRefGoogle Scholar
- 22.Benavides M, Pericay C, Valladares-Ayerbes M, et al. Oxaliplatin in combination with infusional 5-fluorouracil as first-line chemotherapy for elderly patients with metastatic colorectal cancer: a phase II study of the Spanish Cooperative Group for the Treatment of Digestive Tumors. Clin Colorectal Cancer. 2012;11:200–6.PubMedCrossRefGoogle Scholar
- 24.Sastre J, Marcuello E, Masutti B, et al. Irinotecan in combination with fluorouracil in a 48-hour continuous infusion as first-line chemotherapy for elderly patients with metastatic colorectal cancer: a Spanish cooperative group for the treatment of digestive tumors study. J Clin Oncol. 2005;23(15):3545–51.PubMedCrossRefGoogle Scholar