Metastatic Colorectal Cancer Outcomes by Age Among ARCAD First- and Second-Line Clinical Trials

Abstract

Background We evaluated the time to progression and survival outcomes of second-line therapy for metastatic colorectal cancer among adults aged 70 years and older compared to younger adults following progression on first-line clinical trials. Methods Associations between clinical and disease characteristics, time to initial progression and rate of receipt of second-line therapy were evaluated. Time to progression and overall survival were compared between older and younger adults in first- and second-line trials by Cox regression, adjusting for age, sex, Eastern Cooperative Oncology Group Performance Status (ECOG PS), number of metastatic sites and presence of metastasis in the lung, liver or peritoneum. All statistical tests were 2-sided. Results Older adults comprised 16.4% of patients on first-line trials (870 total older adults age >70 years; 4,419 total younger adults age ≤70 years, on first-line trials). Older adults and those with ECOG PS > 0 were less likely to receive second-line therapy than younger adults. Odds of receiving second-line therapy decreased by 11% for each additional decade of life in multivariable analysis (odds ratio = 1.11, 95% confidence interval = 1.02, 1.21, P = .01. Older and younger adults enrolled in second-line trials experienced similar median time to progression and median overall survival (median time to progression = 5.1 vs. 5.2 months, respectively; median overall survival = 11.6 vs. 12.4 months, respectively). Conclusions Older adults were less likely to receive second-line therapy for metastatic colorectal cancer, though we did not observe a statistical difference in survival outcomes vs. younger adults following second-line therapy. Further study should examine factors impacting decisions to treat older adults with second-line therapy. Inclusion of geriatric assessment may provide better criteria regarding the risks and benefits of second-line therapy.

A call for standardized reporting of early-onset colorectal peritoneal metastases

“…PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Sharma et al, 2021;Tabchouri et al, 2021;Yang et al, 2021;Zhou et al, 2021;Flood et al, 2022;Iwasaki et al, 2022;McCleary et al, 2022;Meyer et al, 2022;Nagao et al, 2022).…”

“…Forty-nine papers were excluded from the review for age-related reasons: six studies had 0–3 patients under age 50. Forty-three studies included patients under age 50 but did not present results stratified by age or did not stratify using an age ≤50 years old for stratification; one study provided above/below-age data but failed to include symbols (≥ or ≤) or descriptive text to indicate which group included the cutoff age (Sternberg et al , 1994; Nakae et al , 1995; Nakamura et al , 1999; Akasu et al , 2000; el-Ghazawy et al , 2001; Luna-Pérez et al , 2002; Al-Shamsi et al , 2003; Kanemitsu et al , 2003; Carmignani et al , 2004; Lloyd et al , 2006; Nervi et al , 2006; Lawson et al , 2008; Sobhani et al , 2008; Song et al , 2009; Aghili et al , 2010; Lemmens et al , 2011; Sjo et al , 2011; Lieu et al ., 2014; Park et al , 2014; Saluja et al , 2014; Adachi et al , 2015; Lam et al , 2015; Sica et al , 2015; Simkens et al , 2015; 2016; Maillet et al , 2016; Wang et al , 2016; Cicero et al , 2017; Hojo et al , 2017; Patil et al , 2017; Cigdem Arslan et al , 2018; Kondo et al , 2021; Melli et al , 2021; Rieser et al , 2021a, 2021b; Sharma et al , 2021; Tabchouri et al , 2021; Yang et al , 2021; Zhou et al , 2021; Flood et al , 2022; Iwasaki et al , 2022; McCleary et al , 2022; Meyer et al , 2022; Nagao et al , 2022).…”

Prognostic and predictive impact of metastatic organ involvement on maintenance therapy in advanced metastatic colorectal cancer: Subgroup analysis of patients treated within the PanaMa trial (AIO KRK 0212)

“…First, as this analysis was conducted as a retrospective evaluation of the PanaMa trial, the results should be interpreted as hypothesis generating. Second, owing to limited sample sizes, we refrained from performing subgroup analyses on additional metastatic localization patterns, for example, lung‐limited or peritoneal‐limited metastasis that might be of clinical interest 37 . Accordingly, prognostic and predictive impact of other metastatic patterns could not be detected.…”

“…Second, owing to limited sample sizes, we refrained from performing subgroup analyses on additional metastatic localization patterns, for example, lung-limited or peritoneal-limited metastasis that might be of clinical interest. 37 Accordingly, prognostic and predictive impact of other metastatic patterns could not be detected. Third, distribution of metastatic organ involvement of the cohort analyzed might be biased due to the underlying study design.…”