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Adjuvant therapy in older colorectal cancer patients may offer significant survival benefit
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The use of adjuvant chemotherapy in patients aged 75 years or older who have surgically resected colorectal cancer conferred a survival benefit equal to that seen in clinical trials of younger patients, according to study results.
Despite the fact that patients older than 75 years represent a large number of those who are diagnosed each year with colorectal cancer, little clinical trial data exists evaluating adjuvant chemotherapy in this patient population, specifically those with stage III cancer.
In order to increase knowledge about the effectiveness of adjuvant chemotherapy in this age group, researchers retrospectively examined data from four sources: the SEER program cancer registry and The New York State Cancer Registry, both of which are linked to Medicare claims; the NCCN Outcomes Database, and the Cancer Care Outcomes Research & Surveillance Consortium.
In addition to evaluating the efficacy of any adjuvant therapy, researchers also were looking specifically at the value of adding oxaliplatin to treatment regimens.
The 5,489 patients were categorized as “no chemotherapy” or “chemotherapy.” Those patients who had undergone chemotherapy were further divided into subgroups according to whether their chemotherapy included oxaliplatin.
The survival of those patients who received chemotherapy was significantly better than that of patients who did not undergo chemotherapy. In fact, the researchers found that those patients treated with adjuvant chemotherapy had a survival benefit equivalent to the magnitude of those seen in clinical trials.
In addition, chemotherapy that included oxaliplatin was associated with a trend toward lower mortality in two of the four data sources.
“Clearly, treatment decisions need to be made in the context of individual risk profiles and preferences, but the survival estimates from this work provide benchmarks for consideration and may inform discussions about prognosis,” the researchers wrote.
Perspective
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Leonard Saltz, MD
These data support what the majority of available data have been suggesting: Chronological age alone is not an appropriate discriminating factor in the decision regarding the appropriateness of adjuvant therapy. Healthy older patients have the potential to receive similar benefits from adjuvant chemotherapy as do younger patients. Patients with poor performance status and/or multiple medical co-morbidities do, however, need to take those issues into consideration when deciding whether to accept adjuvant chemotherapy.
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