Abstract 396P
Background
Elderly mCRC patients are underrepresented in studies; and resection rates and outcomes are inferior.
Methods
The prospective Finnish real-life RAXO study included 1086 patients 2012-2018 (Osterlund et al TLRHE 2021, Isoniemi et al BJS 2021). We assessed repeated centralized resectability in mCRC, and overall survival (OS) and Quality of life (QoL) with EQ5D after resection and/or local ablative therapy (LAT) and “systemic therapy only”. Bonferroni corrected ꭓ2 <0.05 denoted with*. Kaplan-Meier estimates and Cox regression (adjusted for ECOG, presentation, primary surgery and sidedness) were analysed.
Results
Elderly >75 (n=181; 17%) had median age 78.3 years (range 75-90) and ≤75 (n=905) 64.3 years (24-75), were males in 59% vs 61%, had ECOG 0 in 16 vs 29%* and 2-3 in 29 vs 15%*, left-sided primary tumour in 65 vs 73%*, operated primary 74 vs 65%*, liver only metastases 36 vs 40%, liver involvement ≥25% 50 vs 51%, synchronous presentation 58 vs 70%*, KRAS/NRAS mutation (mt) in 57 vs 50% and BRAFmt in 12 vs 15%. Upfront resectable (metastases) were 25% of >75 vs 29%* of ≤75, borderline 11 vs 18%, and non-resectable 64 vs 53%*. In upfront local vs centralised assessment resectability was underestimated in 48% of >75 and in 34% of ≤75*, and overestimated in 8% vs 12%. Successfully converted were 10 vs 19%*. R0/1-resections were performed in 19% of >75 vs 32% of ≤75*, R2-resection/LAT in 6 vs 7%, “Systemic only” in 71 vs 59%*. Liver procedure performed in 20% of all > 75 vs 31% of ≤75*, lung 4 vs 8%*, cytoreductive 2 vs 5%, other metastasectomy in 12 vs 7%. Median OS for R0/1-resected was 67 months in >75 vs 83 in ≤75 (HR 1.49 [CI 95% 0.9-2.6], for R2/LAT 32 vs 41 (1.26; 0.6-2.8), and for “Systemic only” 20 vs 21 (1.09; 0.9-2.8), with 5-year OS rates 58 vs 67%, 40 vs 42%, 2 vs 8%. Mean QoL with EQ5D during neoadjuvant therapy was 0.93 in >75 vs 0.88 in ≤75, <6 months from resection 0.93 vs 0.87, 6-18 months 0.93 vs 0.91, >18 months 0.86 vs 0.90, and during 1st line systemic 0.82 vs 0.83.
Conclusions
Resection/LAT was performed in 25% of elderly, with excellent survival and QoL. On central assessment 25% of elderly were upfront resectable and 11% borderline, with local underestimation of resectability in 48%. Fit elderly mCRC patients should be actively treated.
Clinical trial identification
NCT01531621 and EudraCT 2011-003158-24.
Editorial acknowledgement
Legal entity responsible for the study
The RAXO study group represented by the authors.
Funding
Amgen (unrestricted grant), Lilly, Merck KGaA, Roche Finland, Sanofi and Servier (unrestricted grant).
Disclosure
P.J. Osterlund: Financial Interests, Personal, Invited Speaker, Also advisory board, Institutional research funding: Eisai; Financial Interests, Personal, Invited Speaker: Novartis; Nordic Drugs; Financial Interests, Institutional, Invited Speaker: Incyte; Financial Interests, Personal, Invited Speaker, Also advisory board: Roche; Financial Interests, Institutional, Advisory Board: Merck; Financial Interests, Personal, Advisory Board: Amgen; AstraZeneca; Bayer; MSD; Pierre Fabre; Sanofi; Sobi; Financial Interests, Personal, Invited Speaker, Also advisory board without compensation: Servier; Financial Interests, Personal, Invited Speaker, Writing engagement: Nutricia; Incyte; Fresenius Kabi; Financial Interests, Institutional, Research Grant: Amgen; Servier; Non-Financial Interests, Member: Colores patient advocacy group.L. Soveri: Financial Interests, Personal and Institutional, Research Grant: Amgen; Financial Interests, Institutional, Funding: Roche; Sanofi; Servier; Merck; Lilly.K.I. Lehtomaki: Financial Interests, Personal and Institutional, Research Grant, Advisory board: Amgen; Financial Interests, Personal, Advisory Board: Bayer; Financial Interests, Institutional, Research Grant: Servier; Financial Interests, Personal and Institutional, Funding, Advisory board: Roche; Financial Interests, Institutional, Funding: Sanofi; Lilly; Merck. P. Halonen: Financial Interests, Personal and Institutional, Advisory Board: Lilly; MSD; Financial Interests, Personal and Institutional, Research Grant: Amgen; Merck; Financial Interests, Institutional, Research Grant: Sanofi; Servier; Pierre Fabre; Financial Interests, Personal and Institutional, Research Grant: Roche. E.J.T. Österlund: Financial Interests, Personal and Institutional, Research Grant, Speaker: Amgen; Financial Interests, Institutional, Funding: Roche; Sanofi; Servier; Merck; Financial Interests, Institutional, Research Grant: Lilly. H. Stedt: Financial Interests, Personal and Institutional, Funding, Invited speaker, advisory board: Amgen; Financial Interests, Personal and Institutional, Funding, advisory role, advisory board: Roche; Financial Interests, Personal and Institutional, Funding, advisory board: Merck; Financial Interests, Institutional, Funding: Sanofi; Servier; Lilly. A. Lamminmaki: Financial Interests, Institutional, Research Grant: Amgen; Financial Interests, Institutional, Funding: Roche; Sanofi; Merck; Lilly; MSD. S. Aho: Financial Interests, Institutional, Research Grant: Amgen; Lilly; Financial Interests, Institutional, Funding: Roche; Sanofi; Servier; Merck; Financial Interests, Personal and Institutional, Funding: MSD; Celgene. T. Muhonen: Financial Interests, Personal and Institutional, Research Grant, Shares: Amgen; Financial Interests, Personal and Institutional, Funding, Consultation fees: Roche; Financial Interests, Institutional, Funding: Sanofi; Servier; Merck; Financial Interests, Institutional, Research Grant: Lilly. A. Algars: Financial Interests, Personal and Institutional, Research Grant, Advisory Board, Invited speaker: Amgen; Financial Interests, Personal and Institutional, Funding, Invited speaker, advisory board, research grant: Roche; Financial Interests, Personal and Institutional, Research Grant, Advisory Board: Servier; Financial Interests, Personal and Institutional, Funding, Advisory Board: Sanofi; Merck; Lilly; Financial Interests, Institutional, Funding: Nordic Drugs; Financial Interests, Personal, Advisory Board: Bayer; Pierre Fabre. T. Salminen: Financial Interests, Institutional, Research Grant: Amgen; Roche; Sanofi; Servier; Lilly; Financial Interests, Personal, Sponsor/Funding: Pfizer; Pierre Fabre. R. Kallio: Financial Interests, Personal and Institutional, Funding, Advisory board: Roche; Merck; Financial Interests, Personal, Advisory Board: Bayer; MSD; Financial Interests, Personal and Institutional, Research Grant, Advisory board: Servier; Amgen; Financial Interests, Institutional, Funding: Lilly; Financial Interests, Institutional, Funding, Advisory board: Sanofi. E. Heerva: Financial Interests, Personal and Institutional, Funding: Amgen; Roche; Sanofi; Merck; Financial Interests, Institutional, Funding: Servier; Lilly; Financial Interests, Personal, Funding: Bayer; MSD; Pierre Fabre. A. Uutela: Financial Interests, Institutional, Funding: Amgen; Roche; Sanofi; Servier; Merck; Lilly; Bayer; MSD; Pierre Fabre. A. Nordin: Financial Interests, Personal and Institutional, Research Grant: Amgen; Financial Interests, Institutional, Funding: Roche; Sanofi; Servier; Merck; Financial Interests, Institutional, Research Grant: Lilly. L.J. Aroviita: Financial Interests, Institutional, Funding: Sanofi; Merck; Roche; Lilly; Financial Interests, Institutional, Research Grant: Amgen; Servier. P. Nyandoto: Financial Interests, Institutional, Research Grant: Amgen; Servier; Financial Interests, Institutional, Funding: Lilly; Merck; Roche; Sanofi. R. Ristamaki: Financial Interests, Personal and Institutional, Research Grant, Invited speaker, advisory board: Amgen; Financial Interests, Personal and Institutional, Research Grant, Advisory board: Servier; Financial Interests, Personal and Institutional, Funding, Invited speaker, advisory board: Roche; Lilly; Financial Interests, Personal and Institutional, Funding, Advisory board: Sanofi; Merck; Financial Interests, Institutional, Funding: Nordic Drugs. All other authors have declared no conflicts of interest.