Patterns of Use,Safety, and Effectiveness of Targeted Therapies in First-Line Treatment of Metastatic Colorectal Cancer According to Age: The STROMBOLI Cohort Study |
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Authors: | Amandine Gouverneur Juliette Coutureau Jérémy Jové Magali Rouyer Angela Grelaud Sophie Duc Stéphane Gérard Denis Smith Alain Ravaud Cécile Droz Marie-Agnès Bernard Régis Lassalle Annie Forrier-Réglat Pernelle Noize |
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Institution: | 1. Univ Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France;2. Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France;3. CHU de Bordeaux, Pôle de Sante publique, Service de Pharmacologie médicale, Bordeaux, France;4. ADERA, Pessac, France;5. Service de Gériatrie, CHU Bordeaux, Bordeaux, France;6. Service de Gériatrie, CHU Toulouse, Toulouse, France;7. Service d’Oncologie médicale, CHU Bordeaux, Bordeaux, France |
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Abstract: | BackgroundMetastatic colorectal cancer (mCRC) is increasingly treated using targeted therapies. Their real-life evaluation is insufficient, especially in elderly and frail patients. The aim was to describe use, safety, and effectiveness of targeted therapies in first-line mCRC treatment according to age.Patients and MethodsTwo field cohorts of patients initiating bevacizumab or cetuximab for first-line mCRC were pooled. Patients characteristics, use, and safety were compared between younger and elderly patients (<75 vs. ≥75 years). Two-year overall survival (OS) and progression-free survival (PFS) were estimated in both age groups using the Kaplan–Meier method adjusted on factors associated with death or progression identified with Cox multivariate modeling.ResultsEight hundred patients (n = 411, 51.4% bevacizumab) were included: 498 (62.3%) male, median age 64 years, 118 (14.8%) Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥2. Elderly patients (n = 126, 15.8%) were more often treated with 5-fluorouracil alone than younger. Severe adverse events were equivalent across age groups. ECOG-PS ≥1, abnormal hemoglobin, and abnormal alkaline phosphatases were associated with a higher risk of death; OS adjusted on these factors was similar between elderly and younger patients. ECOG-PS ≥1, lung metastases, abnormal hemoglobin, and abnormal creatinine clearance were associated with a higher risk of progression or death; PFS adjusted on these factors was similar across groups.ConclusionDespite treatment adaptations, elderly patients could benefit from targeted therapies as younger without safety warning. |
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Keywords: | Aged Colorectal neoplasm Frail elderly Molecular targeted therapy Neoplasm metastasis |
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