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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2020; 12(6): 604-618
Published online Jun 15, 2020. doi: 10.4251/wjgo.v12.i6.604
Real-world evidence on adjuvant chemotherapy in older adults with stage II/III colon cancer
Atul Batra, Rodrigo Rigo, Dropen Sheka, Winson Y Cheung
Atul Batra, Rodrigo Rigo, Dropen Sheka, Department of Medicine, Tom Baker Cancer Centre, Calgary, Alberta T2N 1N4, Canada
Winson Y Cheung, Department of Oncology, University of Calgary, Calgary, Alberta T2N 4N2, Canada
Author contributions: Batra A, Rigo R, Sheka D and Cheung WY collected the data and wrote the paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Winson Y Cheung, MD, Doctor, Professor, Department of Oncology, University of Calgary, 1331 – 29 Street NW, Calgary, Alberta T2N 4N2, Canada. winson.cheung@ahs.ca
Received: February 24, 2020
Peer-review started: February 24, 2020
First decision: April 9, 2020
Revised: May 8, 2020
Accepted: May 29, 2020
Article in press: May 29, 2020
Published online: June 15, 2020
Processing time: 111 Days and 15.4 Hours
Abstract

Colon cancer represents one of the most common cancers diagnosed in older adults worldwide. The standard of care in resected stage II and stage III colon cancer continues to evolve. While there is unequivocal evidence to suggest both disease free and overall survival benefits with the use of combination chemotherapy in patients with stage III colon cancer, data regarding its use in patients with stage II colon cancer are less clear. Further, although colon cancer is a disease that affects older adults, there is considerable debate on the value of adjuvant chemotherapy in the aging population. In particular, many older patients are undertreated when compared to their younger counterparts. In this review, we will describe the clinical trials that contributed to the current adjuvant chemotherapy approach in colon cancer, discuss representation of older adults in trials and the specific challenges associated with the management of this sub-population, and highlight the role of comprehensive geriatric assessments. We will also review how real-world evidence complements the data gaps from clinical trials of early stage colon cancer.

Keywords: Colon cancer; Older adults; Adjuvant chemotherapy; Real-world evidence

Core tip: Use of adjuvant chemotherapy consisting of fluoropyrimidines with/without oxaliplatin has improved survival outcomes for patients with resected colon cancer, especially in those with stage III disease. However, older adults are often not given the opportunity to benefit from chemotherapy after surgery because undertreatment may occur due to various patient and physician related factors. The issue is further compounded by the limited representation of older adults in clinical trials, resulting in underpowered subgroup analyses that do not provide conclusive answers regarding the utility of adjuvant chemotherapy in the advanced age group. We herein review the role of adjuvant chemotherapy in early stage colon cancer, specifically in the context of the older subpopulation, by focusing on both data from clinical trials and data from real-world evidence sources.