Effect of age on the effectiveness of the first-line standard of care treatment in patients with metastatic colorectal cancer: systematic review of observational studies

Abstract

Purpose Most metastatic colorectal cancer (mCRC) patients are elderly. This systematic review identifies and describes observational studies evaluating the influence of age on first-line treatment effectiveness in real-world practice. Methods Medline and EMBASE were searched up to May 2016. The included studies were those that investigated first-line treatment of mCRC and reported age groups and overall survival (OS), progression-free survival (PFS) or overall response rate (ORR) were included. Studies published before 2008 were excluded. Study quality was assessed using the Newcastle–Ottawa Scale. Data were evaluated by age group (< 70 vs. ≥ 70 years; 65–75 vs. ≥ 75 years) and outcome. A pooled survival median was calculated for patients (cutoff = 70 years). Results In total, 11 articles with 11,063 patients were included. Four studies using a cutoff of 70 years of age reported OS and PFS, and two studies reported ORRs. In terms of OS, all studies showed a higher OS for those < 70 years of age than for those ≥ 70 years of age. PFS did not find differences by age. For ORRs, one study favoured the younger group, while the second study did not differ by age. Based on three studies, the pooled medians for < 70 years of age and ≥ 70 years of age were the same for PFS (10.2) and were 27.0 and 22.9 for OS, respectively. All included studies were of high or acceptable quality. Conclusions The results suggest that age has no effect on PFS. For ORR, the results were inconsistent between studies. Younger patients in general had better OS, which might be partly explained by more aggressive treatment. This treatment seemed not to be guided by performance status or number of metastatic sites. Electronic supplementary material The online version of this article (10.1007/s00432-019-02948-6) contains supplementary material, which is available to authorized users.

Prognostic Value of Prospective Longitudinal CRP to Albumin Ratio among Older Outpatients with Cancer

“…Thus, cluster B could also capture progression of cancer disease, particularly in metastatic setting, which may explain the impressive peak at 9 months. Indeed, the median progression free survival in the first line setting for metastatic cancer is ranging from 5 months to 10 months in lung, breast and colorectal cancers [ 20 , 21 , 22 ]. In addition, an overlap pathway between cancer-cachexia and frailty syndrome in the same cohort has previously been shown [ 23 ].…”

First-line trifluridine/tipiracil plus bevacizumab for unresectable metastatic colorectal cancer: SOLSTICE study design

“…International treatment guidelines refer to inappropriate candidates for intensive therapy in general terms as those who will be unable to tolerate standard-dose combination therapy with a fluoropyrimidine + oxaliplatin or irinotecan, those for whom intensive treatment is not necessary and where the goal is disease control, and those refusing intensive treatment for personal reasons [4,7,8]. Categorization of patients with unresectable mCRC as candidates for intensive therapy is therefore a subjective decision-making process that relies on the treating physician's evaluation of suitability for therapy [10,12]. This represents a major challenge when selecting the most appropriate treatment option for patients with unresectable mCRC.…”

“…Moreover, the definition of elderly (≥65, ≥70 or ≥75 years) differs in the published literature. Therefore, first-line treatment decisions for patients with unresectable mCRC should not be guided by age criteria alone, and should also take into account the patient's CGA results, PS, comorbidities, tumor characteristics, the extent of metastases and their own individual preferences [12,31,32]. In the SOLTSTICE study, the population of patients with low tumor burden mCRC may be defined as those with numerous small unresectable metastases, for example, CRC with numerous, but only, lung metastasis [33].…”

“…Patients with mCRC who are not candidates for intensive therapy are often frail and/or elderly with comorbidities or with a low unresectable tumor burden and are therefore under-represented in clinical trials, which has led to a lack of innovative therapies for this population of patients [10][11][12][13][14][15]. There is therefore a clear unmet need for effective first-line treatment options for patients with mCRC who are not candidates for intensive therapy.…”