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Management of metastatic colorectal cancer in patients ≥70 years - a single center experience
BACKGROUND: Age-standardized mortality rates for metastatic colorectal cancer (mCRC) are highest among elderly patients. In current clinical guidelines, treatment recommendations for this patient population are based on a limited number of clinical trials. PATIENTS AND METHODS: In this monocentric,...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407548/ https://www.ncbi.nlm.nih.gov/pubmed/37560467 http://dx.doi.org/10.3389/fonc.2023.1222951 |
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author | Huemer, Florian Dunkl, Celine Rinnerthaler, Gabriel Schlick, Konstantin Heregger, Ronald Emmanuel, Klaus Neureiter, Daniel Klieser, Eckhard Deutschmann, Michael Roeder, Falk Greil, Richard Weiss, Lukas |
author_facet | Huemer, Florian Dunkl, Celine Rinnerthaler, Gabriel Schlick, Konstantin Heregger, Ronald Emmanuel, Klaus Neureiter, Daniel Klieser, Eckhard Deutschmann, Michael Roeder, Falk Greil, Richard Weiss, Lukas |
author_sort | Huemer, Florian |
collection | PubMed |
description | BACKGROUND: Age-standardized mortality rates for metastatic colorectal cancer (mCRC) are highest among elderly patients. In current clinical guidelines, treatment recommendations for this patient population are based on a limited number of clinical trials. PATIENTS AND METHODS: In this monocentric, retrospective analysis we characterized patients aged ≥70 years undergoing systemic therapy for mCRC and overall survival (OS) was investigated. RESULTS: We included 117 unselected, consecutive mCRC patients aged ≥70 years undergoing systemic therapy for mCRC between February 2009 and July 2022. Median OS was 25.6 months (95% CI: 21.8-29.4). The median age was 78 years (range: 70-90) and 21%, 48%, 26% and 5% had an ECOG performance score of 0, 1, 2, and 3, respectively. The median number of systemic therapy lines was 2 (range: 1-5). The choice of first-line chemotherapy backbone (doublet/triplet versus mono) did not impact OS (HR: 0.83, p=0.50) or the probability of receiving subsequent therapy (p=0.697). Metastasectomy and/or local ablative treatment in the liver, lung, peritoneum and/or other organs were applied in 26 patients (22%) with curative intent. First-line anti-EGFR-based therapy showed a trend towards longer OS compared to anti-VEGF-based therapy or chemotherapy alone in left-sided mCRC (anti-EGFR: 39.3 months versus anti-VEGF: 27.3 months versus chemotherapy alone: 13.8 months, p=0.105). In multivariable analysis, metastasectomy and/or local ablative treatment with curative intent (yes versus no, HR: 0.22, p<0.001), the ECOG performance score (2 versus 0, HR: 3.07, p=0.007; 3 versus 0, HR: 3.66, p=0.053) and the presence of liver metastases (yes versus no, HR: 1.79, p=0.049) were independently associated with OS. CONCLUSIONS: Our findings corroborate front-line monochemotherapy in combination with targeted therapy as the treatment of choice for elderly mCRC patients with palliative treatment intent. Metastasectomy and/or local ablative treatment with curative intent are feasible and may improve OS in selected elderly mCRC patients. |
format | Online Article Text |
id | pubmed-10407548 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-104075482023-08-09 Management of metastatic colorectal cancer in patients ≥70 years - a single center experience Huemer, Florian Dunkl, Celine Rinnerthaler, Gabriel Schlick, Konstantin Heregger, Ronald Emmanuel, Klaus Neureiter, Daniel Klieser, Eckhard Deutschmann, Michael Roeder, Falk Greil, Richard Weiss, Lukas Front Oncol Oncology BACKGROUND: Age-standardized mortality rates for metastatic colorectal cancer (mCRC) are highest among elderly patients. In current clinical guidelines, treatment recommendations for this patient population are based on a limited number of clinical trials. PATIENTS AND METHODS: In this monocentric, retrospective analysis we characterized patients aged ≥70 years undergoing systemic therapy for mCRC and overall survival (OS) was investigated. RESULTS: We included 117 unselected, consecutive mCRC patients aged ≥70 years undergoing systemic therapy for mCRC between February 2009 and July 2022. Median OS was 25.6 months (95% CI: 21.8-29.4). The median age was 78 years (range: 70-90) and 21%, 48%, 26% and 5% had an ECOG performance score of 0, 1, 2, and 3, respectively. The median number of systemic therapy lines was 2 (range: 1-5). The choice of first-line chemotherapy backbone (doublet/triplet versus mono) did not impact OS (HR: 0.83, p=0.50) or the probability of receiving subsequent therapy (p=0.697). Metastasectomy and/or local ablative treatment in the liver, lung, peritoneum and/or other organs were applied in 26 patients (22%) with curative intent. First-line anti-EGFR-based therapy showed a trend towards longer OS compared to anti-VEGF-based therapy or chemotherapy alone in left-sided mCRC (anti-EGFR: 39.3 months versus anti-VEGF: 27.3 months versus chemotherapy alone: 13.8 months, p=0.105). In multivariable analysis, metastasectomy and/or local ablative treatment with curative intent (yes versus no, HR: 0.22, p<0.001), the ECOG performance score (2 versus 0, HR: 3.07, p=0.007; 3 versus 0, HR: 3.66, p=0.053) and the presence of liver metastases (yes versus no, HR: 1.79, p=0.049) were independently associated with OS. CONCLUSIONS: Our findings corroborate front-line monochemotherapy in combination with targeted therapy as the treatment of choice for elderly mCRC patients with palliative treatment intent. Metastasectomy and/or local ablative treatment with curative intent are feasible and may improve OS in selected elderly mCRC patients. Frontiers Media S.A. 2023-07-25 /pmc/articles/PMC10407548/ /pubmed/37560467 http://dx.doi.org/10.3389/fonc.2023.1222951 Text en Copyright © 2023 Huemer, Dunkl, Rinnerthaler, Schlick, Heregger, Emmanuel, Neureiter, Klieser, Deutschmann, Roeder, Greil and Weiss https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Oncology Huemer, Florian Dunkl, Celine Rinnerthaler, Gabriel Schlick, Konstantin Heregger, Ronald Emmanuel, Klaus Neureiter, Daniel Klieser, Eckhard Deutschmann, Michael Roeder, Falk Greil, Richard Weiss, Lukas Management of metastatic colorectal cancer in patients ≥70 years - a single center experience |
title | Management of metastatic colorectal cancer in patients ≥70 years - a single center experience |
title_full | Management of metastatic colorectal cancer in patients ≥70 years - a single center experience |
title_fullStr | Management of metastatic colorectal cancer in patients ≥70 years - a single center experience |
title_full_unstemmed | Management of metastatic colorectal cancer in patients ≥70 years - a single center experience |
title_short | Management of metastatic colorectal cancer in patients ≥70 years - a single center experience |
title_sort | management of metastatic colorectal cancer in patients ≥70 years - a single center experience |
topic | Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407548/ https://www.ncbi.nlm.nih.gov/pubmed/37560467 http://dx.doi.org/10.3389/fonc.2023.1222951 |
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