Palliative Chemotherapy for Patients 70 Years of Age and Older with Metastatic Colorectal Cancer: A Single-Centre Experience

Abstract

Background: Metastatic colorectal cancer (MCRC) commonly affects elderly people, an understudied subset of patients. We analyzed the survival impact of the first and subsequent lines of chemotherapy in eligible non-trial patients 70 years of age and older with MCRC treated between 2004 and 2012. Methods: This single-centre retrospective analysis estimated overall survival (OS) and progression-free survival (PFS) using the Kaplan–Meier method. Multivariate analysis was used to adjust for age, sex, Eastern Cooperative Oncology Group performance status, score on the Charlson comorbidity index, dependency in activities of daily living, and exposure to 1 or more chemotherapy doublets, capecitabine alone, or best supportive care (BSC). Results: Of 109 patients identified, 29 elected BSC, and 80 received chemotherapy. In multivariate analysis, age was not associated with OS [hazard ratio (HR): 0.99; 95% confidence interval (CI): 0.92 to 1.05], but a performance status of 2 or higher was associated with a decreased likelihood of survival (HR: 3.12; 95% CI: 1.87 to 5.76), and exposure to 1 or more doublets was associated with improved survival (HR: 0.33; 95% CI: 0.17 to 0.66). In univariate analysis, a trend toward improved OS was observed for first-line doublet chemotherapy compared with capecitabine (HR: 0.66; 95% CI: 0.41 to 1.07), and PFS was superior (HR: 0.46; 95% CI: 0.26 to 0.84). Compared with exposure to 1 doublet, exposure to the 3 potential cytotoxic chemotherapies was not associated with improved OS (HR: 0.77; 95% CI: 0.41 to 1.43). The incidence of neutropenia with first-line folfiri was 40%; the incidences of bevacizumab-related arterial and venous thrombosis were both 8%. Conclusions: Exposure to 1 or more doublet chemotherapies for MCRC was associated with better outcomes in non-trial patients 70 years of age and older. Elderly patients treated with palliative chemotherapy and bevacizumab should be monitored carefully for arterial and venous thrombotic events.