DOI QR코드

DOI QR Code

First-Line Mono-Chemotherapy in Frail Elderly Patients with Metastatic Colorectal Cancer

  • Varol, Umut (Katip Celebi University Ataturk, Izmir Tepecik Training and Research Hospital) ;
  • Dirican, Ahmet (Katip Celebi University Ataturk, Izmir Tepecik Training and Research Hospital) ;
  • Yildiz, Ibrahim (Katip Celebi University Ataturk, Izmir Tepecik Training and Research Hospital) ;
  • Oktay, Esin (Adnan Menderes University Faculty of Medicine) ;
  • Degirmenci, Mustafa (Medical Oncology Clinic, Izmir Tepecik Training and Research Hospital) ;
  • Alacacioglu, Ahmet (Katip Celebi University Ataturk, Izmir Tepecik Training and Research Hospital) ;
  • Barutca, Sabri (Adnan Menderes University Faculty of Medicine) ;
  • Karabulut, Bulent (Department of Internal Medicine, Division of Medical Oncology, Ege University Faculty of Medicine) ;
  • Uslu, Ruchan (Department of Internal Medicine, Division of Medical Oncology, Ege University Faculty of Medicine)
  • Published : 2014.04.01

Abstract

Background: Unlike for fit elderly metastatic colorectal cancer (mCRC) patients, general approaches to initial treatment for the frail older mCRC patients are not clear. Our aim was to evaluate the efficiency and safety of first-line single-agent treatment in one such group. Materials and Methods: We retrospectively evaluated mCRC patients aged 70 or older with an Eastern Cooperative Oncology Group performance score of 2. They had no prior treatment and underwent first-line single-agent capecitabine or other monotherapies until disease progression or unacceptable toxicity. Results: Thirty-six patients were included. Most (n:28, 77.8%) were treated with capecitabine. One patient achieved a complete response and 5 patients had a partial response for an overall response rate of 16.6%. Twelve patients (33.3%) remained stable. Median progression free survival was 5 months (confidence interval (CI), %; 3.59-6.40) and median overall survival was 10 months (95 CI%; 8.1-11.8). Grade 3-4 toxicity was found in 6 patients (16.6%). Febrile neutropenia was not observed and there were no toxicity-associated deaths. Conclusions: Capecitabine is a safe chemotherapeutic agent with moderate activity for first-line treatment of older metastatic colorectal cancer patients with limited performance status.

Keywords

References

  1. Aparicio T, Desrame J, Lecomte T, et al (2003). Oxaliplatin- or irinotecan-based chemotherapy for metastatic colorectal cancer in the elderly. Br J Cancer, 89, 1439-44. https://doi.org/10.1038/sj.bjc.6601310
  2. Aparicio T, Jouve JL, Teillet L, et al ( 2013). Geriatric factors predict chemotherapy feasibility: ancillary results of FFCD 2001-02 phase III study in first-line chemotherapy for metastatic colorectal cancer in elderly patients. J Clin Oncol, 31, 1464-70. https://doi.org/10.1200/JCO.2012.42.9894
  3. Arkenau HT, Graeven U, Kubicka S, et al (2008). AIO colorectal study group. oxaliplatin in combination with 5-fluorouracil/leucovorin or capecitabine in elderly patients with metastatic colorectal cancer. Clin Colorectal Cancer, 7, 60-4. https://doi.org/10.3816/CCC.2008.n.009
  4. Benavides M, Pericay C, Valladares-Ayerbes M, et al (2012). Oxaliplatin in combination with infusional 5-fluorouracil as first-line chemotherapy for elderly patients with metastatic colorectal cancer: a phase II study of the Spanish cooperative group for the treatment of digestive tumors. Clin Colorectal Cancer, 11, 200-6. https://doi.org/10.1016/j.clcc.2012.01.003
  5. Berretta M, Zanet E, Nasti G, et al (2012). Oxaliplatin-based chemotherapy in the treatment of elderly patients with metastatic colorectal cancer (CRC). Arch Gerontol Geriatr, 55, 271-5. https://doi.org/10.1016/j.archger.2011.08.016
  6. Duffour J, Roca L, Bressolle F, et al (2010). Clinical impact of intesified 5-Fluorouracil-based chemotherapy using a prospective pharmacokinetically-guided dosing approach: comparative study in elderly and non-elderly patients with metastatic colorectal cancer. J Chemother, 22, 179-85. https://doi.org/10.1179/joc.2010.22.3.179
  7. Eisenhauer EA, Therasse P, Bogaerts J, et al (2009). New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer, 45, 228-47. https://doi.org/10.1016/j.ejca.2008.10.026
  8. Feliu J, Escudero P, Llosa F, et al (2005). Capecitabine as first-line treatment for patients older than 70 years with metastatic colorectal cancer: an oncopaz cooperative group study. J Clin Oncol, 23, 3104. https://doi.org/10.1200/JCO.2005.06.035
  9. Folprecht G, Cunningham D, Ross P, et al (2004). Efficacy of 5-fluorouracil-based chemotherapy in elderly patients with metastatic colorectal cancer: a pooled analysis of clinical trials. Ann Oncol, 15, 1330-8. https://doi.org/10.1093/annonc/mdh344
  10. Francois E, Berdah JF, Chamorey E, et al (2008). Use of the folinic acid/5-fluorouracil/irinotecan (FOLFIRI 1) regimen in elderly patients as a first-line treatment for metastatic colorectal cancer: a phase II study. Cancer Chemother Pharmacol, 62, 931-6. https://doi.org/10.1007/s00280-008-0681-2
  11. Hong YS, Jung KH, Kim HJ, et al (2013). Randomized phase II study of capecitabine with or without oxaliplatin as first-line treatment for elderly or fragile patients with metastatic colorectal cancer: a prospective, multicenter trial of the Korean cancer study group CO06-01. Am J Clin Oncol, 36, 565-71 https://doi.org/10.1097/COC.0b013e31825d52d5
  12. Jackson NA, Barrueco J, Soufi-Mahjoubi R, et al (2009). Comparing safety and efficacy of first-line irinotecan/fluoropyrimidine combinations in elderly versus nonelderly patients with metastatic colorectal cancer: findings from the bolus, infusional, or capecitabine with camptostar-celecoxib study. Cancer, 115, 2617-29. https://doi.org/10.1002/cncr.24305
  13. Jehn CF, Boning L, Kroning H, Possinger K, Luftner D (2012) Cetuximab-based therapy in elderly comorbid patients with metastatic colorectal cancer. Br J Cancer, 106, 274-8. https://doi.org/10.1038/bjc.2011.554
  14. Kozloff MF, Berlin J, Flynn PJ, et al (2010). Clinical outcomes in elderly patients with metastatic colorectal cancer receiving bevacizumab and chemotherapy: results from the BRiTE observational cohort study. Oncology, 78, 329-39. https://doi.org/10.1159/000320222
  15. Kuboki Y, Mizunuma N, Ozaka M, et al (2011). Grade 3/4 neutropenia is a limiting factor in second-line FOLFIRI following FOLFOX4 failure in elderly patients with metastatic colorectal cancer. Oncol Lett, 2, 493-8. https://doi.org/10.3892/ol.2011.260
  16. Meulenbeld HJ, Creemers GJ, (2007). First-line treatment strategies for elderly patients with metastatic colorectal cancer. Drugs Aging, 24, 223-8. https://doi.org/10.2165/00002512-200724030-00004
  17. Mitry E, Rougier P (2009). Review article: benefits and risks of chemotherapy in elderly patients with metastatic colorectal cancer. Aliment Pharmacol Ther, 29, 161-71. https://doi.org/10.1111/j.1365-2036.2008.03867.x
  18. Nguyen HL, Hwang J (2009). Treatment of metastatic colorectal cancer in the elderly. Curr Treat Options Oncol, 10, 287-95. https://doi.org/10.1007/s11864-009-0111-7
  19. Obeidat NA, Pradel FG, Zuckerman IH, DeLisle S, Mullins CD (2009). Outcomes of irinotecan-based chemotherapy regimens in elderly medicare patients with metastatic colorectal cancer. Am J Geriatr Pharmacother, 7, 343-54. https://doi.org/10.1016/j.amjopharm.2009.11.005
  20. Oken MM, Creech RH, Tormey DC, et al (1982). Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol, 6, 649-55.
  21. Rosati G, Cordio S, Tucci A, et al (2005). Phase II trial of oxaliplatin and tegafur/uracil and oral folinic acid for advanced or metastatic colorectal cancer in elderly patients. Oncolog, 69, 122-9. https://doi.org/10.1159/000087814
  22. Sastre J, Aranda E, Gravalos C, et al (2011). First-line single-agent cetuximab in elderly patients with metastatic colorectal cancer. a phase II clinical and molecular study of the Spanish group for digestive tumor therapy (TTD). Crit Rev Oncol Hematol, 77, 78-84. https://doi.org/10.1016/j.critrevonc.2009.11.005
  23. Sastre J, Marcuello E, Masutti B, et al (2005). Cooperative group for the treatment of digestive tumors. Irinotecan in combination with fluorouracil in a 48-hour continuous infusion as first-line chemotherapy for elderly patients with metastatic colorectal cancer: a Spanish cooperative group for the treatment of digestive tumors study. J Clin Oncol, 23, 3545-51. https://doi.org/10.1200/JCO.2005.03.004
  24. Satram-Hoang S, Lee L, Yu S, et al (2013). Comparative effectiveness of chemotherapy in elderly patients with metastatic colorectal cancer. J Gastrointest Cancer, 44, 79-88. https://doi.org/10.1007/s12029-012-9450-x
  25. Seymour MT, Thompson LC, Wasan HS, et al (2011). FOCUS2 Investigators; National Cancer Research Institute Colorectal Cancer Clinical Studies Group. Chemotherapy options in elderly and frail patients with metastatic colorectal cancer (MRC FOCUS2): an open-label, randomised factorial trial. Lancet, 377, 1749-59. https://doi.org/10.1016/S0140-6736(11)60399-1
  26. Souglakos J, Pallis A, Kakolyris S, et al (2005). Combination of irinotecan (CPT-11) plus 5-fluorouracil and leucovorin (FOLFIRI regimen) as first line treatment for elderly patients with metastatic colorectal cancer: a phase II trial. Oncology, 69, 384-90. https://doi.org/10.1159/000089992
  27. Trotti A, Colevas AD, Setser A, et al (2003). CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol, 13, 176-81. https://doi.org/10.1016/S1053-4296(03)00031-6
  28. Vamvakas L, Athanasiadis A, Karampeazis A, et al (2010). Clinical outcome of elderly patients with metastatic colorectal cancer treated with FOLFOXIRI versus FOLFIRI: Subgroup analysis of a randomized phase III trial from the hellenic oncology research group (HORG). Crit Rev Oncol Hematol, 76, 61-70. https://doi.org/10.1016/j.critrevonc.2009.08.003
  29. Vrdoljak E, Omrcen T, Boban M, Hrabar A, (2011). Phase II study of bevacizumab in combination with capecitabine as first-line treatment in elderly patients with metastatic colorectal cancer. Anticancer Drugs, 22, 191-7. https://doi.org/10.1097/CAD.0b013e3283417f3e
  30. Yoshimatsu K, Yokomizo H, Fujimoto T, et al (2007). First-line chemotherapy with low-dose leucovorin plus 5-fluorouracil (LV/5-FU) for elderly patients with metastatic colorectal cancer. Anticancer Res, 27, 1641-4.

Cited by

  1. Capecitabine Pattern of Usage, Rate of Febrile Neutropaenia and Treatment Related Death in Asian Cancer Patients in Clinical Practice vol.16, pp.4, 2015, https://doi.org/10.7314/APJCP.2015.16.4.1449
  2. Estimating Radiation Therapy Toxicity and Tolerability with Comprehensive Assessment Parameters in Geriatric Cancer Patients vol.16, pp.5, 2015, https://doi.org/10.7314/APJCP.2015.16.5.1965