634 - Second and third line chemotherapy regimens in elderly medicare stage 4 colon cancer patients

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Anti-Cancer Agents & Biologic Therapy
Geriatric Oncology
Colon Cancer
Presenter Kaloyan Bikov
Authors K. Bikov1, C..D. Mullins2, E. Onukwugha3, B. Seal4, N. Hanna5
  • 1Phsr, University of Maryland, 21201 - Baltimore/US
  • 2Phsr, Univ of MD, 21201 - Baltimore, MD/US
  • 3Phsr, Univ of MD, 21201 - Baltimore/US
  • 4Health Economics And Outcomes Research, Bayer HealthCare, 07470 - Wayne, NJ/US
  • 5Surgery, Univ of MD, 21201 - Baltimore/US



NCCN guidelines for stage 4 colon cancer (CC4) patients provide general guidance on which chemotherapies and targeted therapies improve survival or quality of life but do not provide specific treatment (TX) recommendations. The guidelines suggest that TX is highly individualized and no single treatment is right for everyone. This leads to variation in both the number and types of TX lines, especially for elderly patients where there are larger evidence gaps.


Elderly (65+) SEER-Medicare patients diagnosed with CC4 in 2003-2007 were followed through death or 2009 to examine variation across sub-groups in the number of TX lines. We examined NCCN treatments that included any combination of 5-fluorouracil and/or (levo) leucovorin (5FU/LV), irinotecan (IRI), oxaliplatin (OX), and bevacizumab, cetuximab, or panitumumab (collectively identified as BIOLOGICS). Certain non-NCCN treatments were also considered as possible last TX line. A hierarchy categorized treatments as: 1) IROX (IRI + OX); 2) IRI or OX; 3) 5FU/LV; 4) BIOLOGICS without chemotherapy; and 5) other TX. Gaps in TX or changes from OX or IRI to 5FU/LV were not considered new lines.


Of 3,263 CC4 patients who received TX, 1,166 (36%) went on to second line TX. The most common sequences of TX lines were OX to IRI (49%), IRI to OX (14%), 5FU/LV to OX (12%) and 5FU/LV to IRI (12%). Approximately 6% switched from chemotherapy to BIOLOGICS alone only 3.6% ever used IROX. Of second line patients, 244 (21%) had a third line of treatment. The most frequent sequence for 3 TX lines were 5FU/LV to OX to IRI (26%), OX to IRI to MNCLA alone (25%); 5FU/LV to IRI to OX (14%); and IRI to OX to MNCLA alone (6%).


The number of TX lines and the sequence of TX regimens vary considerably across elderly CC4 patients. OX to IRI for first and second line TX was the most common sequence. The choice of initial and subsequent treatment regimens impacts the total number of treatment lines receipt and survival. Further investigation is warranted to examine the relationship between patient and provider characteristics and choice of treatment.


C.D. Mullins: C. Daniel Mullins, PhD receives consulting income from Amgen, Bayer, BMS, Celgene, GSK, Mitsubishi, Novartis, Novo Nordisk, Novartis, and Pfizer. He also receives research funding from Bayer and Pfizer.

E. Onukwugha: Ebere Onukwugha receives consulting income from Pfizer and grant support from Bayer, Novartis, and Pfizer.

B. Seal: Brian Seal is an employee of Bayer HealthCare.

All other authors have declared no conflicts of interest.