603P - Frequency of second and third line treatment among elderly medicare stage 4 colon cancer patients

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Anticancer agents
Geriatric Oncology
Colon and Rectal Cancer
Biological Therapy
Presenter C. Daniel Mullins
Authors C..D. Mullins1, K. Bikov2, E. Onukwugha2, N. Hanna3, B. Seal4
  • 1Phsr, Univ of MD, 21201 - Baltimore, MD/US
  • 2Phsr, Univ of MD, 21201 - Baltimore/US
  • 3Surgery, Univ of MD, 21201 - Baltimore/US
  • 4Health Economics And Outcomes Research, Bayer HealthCare, 07470 - Wayne, NJ/US



Stage 4 colon cancer (CC4) patients may receive multiple lines of chemotherapy and/or biologics as treatment (TX) to improve survival or quality of life. The tendency to use less aggressive treatment with elderly CC4 patients suggests that elderly CC4 patients may receive fewer TX lines than equivalent younger patients.


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 7,937 elderly CC4 patients, 3,263 (41%) received any TX, while 1,166 (15% of all, 36% of TX) and 244 (3% of all, 7% of TX) received second and third line TX, respectively. Fewer than 1% of treated patients had a fourth TX line. Among the TX group, relatively younger (p < 0.01), married (48 vs. 39%, p < 0.01) and urban (45 vs. 39, p = 0.04) patients were more likely to go on to second line TX. Medicare buy-in coverage, which generally indicates dual Medicaid-Medicare coverage (40 vs. 45%, p = 0.05), lowered the likelihood of second line TX. Having comorbidities impacted receipt of initial TX (CCI = 0: 44%, CCI = 1: 42%, CCI = 2: 28%; p < 0.01) and the likelihood of second (CCI = 0: 46%, CCI = 1: 42%, CCI = 2: 39%; p= 0.02) but not third TX (CCI = 0: 19%, CCI = 1: 21%, CCI = 2: 15%; p = 0.3) lines conditional upon receipt of prior line treatment. There was no significant association between second line TX and race/ethnicity or gender. There was no significant association between the examined characteristics and receipt of third line TX.


One in three elderly CC4 patients who received initial TX received a second TX line. The likelihood of having a second TX line was associated with age, marital status, urbanicity, and comorbidity burden. Only one in fourteen elderly CC4 patients had a third TX.


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.