Younger, older patients with metastatic colorectal cancer have similar survival outcomes
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Younger and older patients with metastatic colorectal cancer had similar survival outcomes despite differences in fitness levels and treatment intensity, according to study results published in Journal of the National Cancer Institute.
The lack of a significant survival benefit in the CALGB/SWOG 80405 trial for those with young-onset disease — who typically have more favorable characteristics such as left-sided tumors and receive higher doses of chemotherapy — may be due to diagnosis at more advanced stages, differences in underlying tumor biology or other, unidentified factors increasing disease aggression, researchers wrote.
“The incidence of young-onset colorectal cancer (yoCRC) — colorectal cancer diagnosed in patients [aged younger than 50 years] — is increasing,” Marla Lipsyc-Sharf, MD, clinical fellow in oncology at Dana-Farber Cancer Institute/Mass General Brigham, told Healio “Colorectal cancer is expected to become the leading cause of cancer death in adults aged 20 to 49 years by the year 2040. It is important to understand survival in this population and understand if this is clinically different from survival in patients aged 50 years and older.”
The analysis — the first to compare OS among younger vs. older participants in a clinical trial of treatment for metastatic colorectal cancer, according to Dana-Farber researchers —
included 2,326 eligible patients (median age, 59.1 years; 22.1% aged younger than 50 years at study entry, 58.3% male; 81.5% white). The yoCRC cohort consisted of patients aged younger than 50 years at study entry (median age, 44.3 years). Median age of patients 50 years and older was 62.5 years.
OS served as the primary outcome; investigators assessed PFS as a secondary outcome.
Lipsyc-Sharf and colleagues found no statistically significant difference between patients with young-onset vs. older-onset disease in median OS (27.07 vs. 26.12 months; adjusted HR = 0.98; 95% CI, 0.88-1.1) or median PFS (10.87 vs. 10.55 months; adjusted HR = 1.02; 95% CI, 0.92-1.13).
Patients aged younger than 35 years had the shortest median OS (21.95 months; adjusted HR vs. older-onset patients = 1.08; 95% CI, 0.81-1.44).
“It is not clear why the youngest patients may have a worse prognosis,” Lipsyc-Sharf said. “Though additional research will be needed to confirm this finding given the small number of these very young patients, this is concerning.”
Lipsyc-Sharf told Healio this finding, as well as factors contributing to increased incidence of colorectal cancer among younger patients, remains an active area of investigation.
“This is the motivation behind the BEYOND CRC Project: Better Understanding of Young-Onset Colorectal Cancer, here at Dana-Farber Cancer Institute,” Lipsyc-Sharf said of the work led by Kimmie Ng, MD, MPH, director of the Young-Onset Colorectal Cancer Center at Dana-Farber.
In the BEYOND CRC Project, investigators are actively collecting clinical data and biospecimens to investigate why colorectal cancer incidence has increased among young adults, as well as why survival outcomes have not improved as they might expect given traditionally favorable prognostic factors, Lipsyc-Sharf told Healio.
“This very young population deserves additional study,” Lipsyc-Sharf said. “It is important that patients and clinicians adopt the new U.S. Preventive Services Task Force recommendations for colorectal screening, in which the starting age of screening was lowered from age 50 [years] to age 45 [years]. Patients should discuss with their oncologists how their family members should proceed with screening.”
For more information:
Marla Lipsyc-Sharf, MD, can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; email: mlipsync-sharf@partners.org.
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