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P-269 Efficacy and safety of doublet adjuvant chemotherapy for elderly patients with stage III colorectal cancer

2023; Elsevier BV; Volume: 34; Linguagem: Inglês

10.1016/j.annonc.2023.04.325

1569-8041

S. Silva, Helena Guedes, E. Neto, A. Guedes, João P. Cabral, Bruno Pereira, Inês Leão, Miguel Castelo‐Branco, Ana Raquel Monteiro, Raquel Basto, Andreia Capela, Antonio Pinto, S. Custódio, Joana Marinho,

Colorectal Cancer Surgical Treatments

For stage III disease, the benefits of adjuvant chemotherapy (ChT) with fluoropyrimidine are well established. There is conflicting evidence on the benefit of the addition of oxaliplatin in disease outcomes in patients ≥70 years, as this population is underrepresented in most of these trials. The likelihood of toxicity from doublet ChT regimens is increased in older adults (OA), however patient age alone is not predictive, and a geriatric assessment (GA) is generally required to determine functional reserve and life expectancy. The aim of this work was to assess differences in the efficacy and safety of a doublet regimen in comparison to single-agent ChT in stage III OA with colorectal cancer (CRC). Single-center, retrospective cohort study of OA aged ≥ 70 years with stage III CRC from 2015 to 2022. Chi-square and Fisher's exact tests were used to analyze predictors of adverse events. Kaplan-Meier was used to identify associations between doublet and single-agent ChT and overall survival (OS) and disease-free survival (DFS). A total of 56 patients were included: 32 (57.1%) were treated with oxaliplatin-based ChT (group A) and 24 (42.9%) with single-agent fluoropyrimidine (group B). Median age was 72 years (IQR 71-75) for group A and 76 years (IQR 73-78) for group B. The majority of patients in both groups had an ECOG-PS 0-1: 93.8%, and 91.7%, with a median Charlson comorbidity index of 6 (IQR 5-7). High-risk patients (T4 and/or N2) were 37.5% in group A and 33.3% in group B. More grade ≥ 3 toxicities occurred in group A (65.6%) vs 50.0% for group B, mostly neutropenia (12.5% vs 4.2%), peripheral neuropathy (15.6% vs 0%) and diarrhea (21.9% vs 16.7%). Dose reductions due to toxicities were more frequent in group A (62.5% vs 41.7%, p=0.122). Because of severe toxicities, treatment had to be stopped early in both groups: in 43.8% and 41.7% of patients in groups A and B, p=0.876. Median DFS was not reached with a median follow-up of 28 months (IQR 11-52). Relapse occurred in 25.0% in group A and 33.3% in group B, p=0.495. The 12-month DFS was 80.0% and 65.2% (groups A and B). With a median follow-up of 42 months (IQR 16 – 62), median OS was not reached. At 24 months, 86.3% and 64.9% of patients from groups A and B were alive. When compared to single-agent, doublet ChT regimens for older patients have higher toxicities and a larger need for dose adjustments. However, as illustrated in this real-world patient population cohort, adjuvant ChT with oxaliplatin-based regimens is feasible in selected fit elderly patients, with fewer relapses and better DFS and OS rates when compared to a single agent, though this difference is not statistically significant. A careful evaluation of patients with GA to maximize the risk/benefit ratio is warranted to select the best treatment option.