P-0210 - Under prescription of target therapy in first-line metastatic colorectal cancer in elderly people: a cohort study in a French center

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Geriatric Oncology
Colon Cancer
Rectal Cancer
Presenter Amaury Daste
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors A. Daste1, A. Fourrier-réglat2, D. Smith3, P. Noize2, M. Rouyer2, E. Terrebonne4, A. Ravaud5
  • 1Service D'oncologie Médicale, Hôpital Saint-André, Centre Hospitalier Universitaire, Bordeaux/FR
  • 2Service de Pharmacologie Clinique, Centre Hospitalier Universitaire, Bordeaux/FR
  • 3University Hospital, Bordeaux/FR
  • 4Service d' Hépato-Gastroentérologie et d'Oncologie Digestive du Groupe Hospitalier Sud, Hôpital Haut Lévèque, Centre Hospitalier Universitaire, Pessac/FR
  • 5Service d'Oncologie Médicale, Hôpital Saint-André, Centre Hospitalier Universitaire, Bordeaux/FR

Abstract

Introduction

Elderly people are often under-represented in clinical trials of metastatic colorectal cancer (mCRC). Although the safety and effectiveness of the bevacizumab-based treatment in elderly people has been found in an observational cohort study, little data has been reported on the treatment of elderly patients in general. We conducted a cohort study to evaluate the use of target therapies (TT), including anti VEGF and anti EGF-R, in patients aged >or = 75 years.

Methods

We included all consecutive patients aged >or = 75 years seen for decision of first-line mCRC treatment in the Bordeaux University Hospital from 2008 to 2012. Socio-demographic characteristics and comorbidities were first compared between treated and untreated patients and, then, between treatment groups (TT vs no TT) as well as type and patterns of chemotherapy/ TT used and adverse events. Median progression free survival (PFS) and median overall survival (OS) were estimated.

Results

We identified 75 patients (median age: 82 years); 12% (n = 9) had an oncogeriatric consultation. No specific treatment was decided for 16% of them (n = 12). Older age (p = 0.002), Eastern Cooperative Oncology Group (ECOG) performance status >2 (p < 0.001), alteration of mobility (p < 0.001), and cognitive disorders (p = 0.002) were more frequent in untreated patients. Among the treated patients excluding 5 patients treated with only anti EGF-R and one patient who did not receive the treatment (capecitabine) (n = 57), TT were administered in 33 patients (44%) of all cohort. TT was associated with a polychemotherapy in 87.9% of patients (n = 29) and with a monochemotherapy in 12.1% (n = 4). Bevacizumab was administered to 75.8% (n = 25) and anti EGF-R therapy to 24.2% (n = 8) of the TT group. Older age (p = 0.01), ECOG >2 (p < 0.001), and arterial hypertension (p = 0.04) were more frequent in patients treated without TT. A chemotherapy dose reduction was more often performed in patients without TT (83.3% Vs 60.6%, p = 0.06). The number of adverse events was greater in the TT group: 50% of patients (n = 12) in non-TT group did not have a serious adverse event vs 21.2% (n = 7) in TT group (p = 0.05). When excluding patients who underwent metastasectomy after first-line therapy, median PFS was 10.3 months in the TT group and 3.6 months in the non-TT, median OS was 15.1 months and 8.6 months, respectively.

Conclusion

In routine clinical practice, many elderly patients with mCRC do not receive anticancer therapy and few patients have a geriatric evaluation. Elderly patients receiving TT in first-line therapy of mCRC were selected and represented less than half of patients seen for first line mCRC. Patients who received TT had more serious adverse events but better survival outcomes. The proportion of patients treated with TT could be increased with more oncogeriatric evaluations.