Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

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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. Materials 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). 2-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. Results800 patients (51.4% bevacizumab) were included: 62.3% male, median age 64 years, 14.8% ECOG-PS ≥2. Elderly patients (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.MicroAbstract: Elderly patients are excluded from clinical trials, yet they can be treated in clinical practice. This large cohort of metastatic colorectal cancer patients treated in first-line with targeted therapies reinforces their benefit in elderly patients. Targeted therapies safety and effectiveness are similar between elderly and younger metastatic colorectal cancer patients.Clinical Practice Points: Bevacizumab or cetuximab combined with chemotherapy has demonstrated improved survival outcomes in first-line mCRC treatment.In real-life settings, the use of bevacizumab or cetuximab in elderly mCRC patients resulted in outcomes close to those in younger patients. After adjustment, there was no difference between elderly and younger patients in terms of OS (median 23.

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