Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2022; 10(28): 10066-10076
Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10066
Clinical outcomes of targeted therapies in elderly patients aged ≥ 80 years with metastatic colorectal cancer
Hee Ryeong Jang, Hui-Young Lee, Seo-Young Song, Kyu-Hyoung Lim
Hee Ryeong Jang, Hui-Young Lee, Seo-Young Song, Kyu-Hyoung Lim, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do 24289, South Korea
Author contributions: Lim KH contributed to design and data analysis, drafted the manuscript, contributed to the conception and critically revised the manuscript; Jang HR contributed to data analysis and critically revised the manuscript; Jang HR, Lee HY, Song SY contributed to data acquisition and analysis; all authors read and approved the final manuscript.
Institutional review board statement: The study was performed in full accordance with the precepts of the Declaration of Helsinki. This study was approved by the Institutional Review Board of Kangwon National University Hospital (IRB No: KNUH-2021-03-008).
Informed consent statement: Patients’ consents were waived from the institutional review board.
Conflict-of-interest statement: All authors declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kyu-Hyoung Lim, MD, PhD, Professor, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, 156 Baengnyeong-ro, Gangwon-do 24289, South Korea. kyuhyoung.lim@kangwon.ac.kr
Received: June 7, 2022
Peer-review started: June 7, 2022
First decision: July 12, 2022
Revised: July 26, 2022
Accepted: August 17, 2022
Article in press: August 17, 2022
Published online: October 6, 2022
Processing time: 112 Days and 8.1 Hours
Abstract
BACKGROUND

The 5-fluorouracil-based chemotherapy combined with oxaliplatin or irinotecan is usually used in colorectal cancer (CRC). The addition of a targeted agent (TA) to this combination chemotherapy is currently the standard treatment for metastatic CRC. However, the efficacy and safety of combination chemotherapy for metastatic CRC in patients aged above 80 years has yet to be established.

AIM

To assess the clinical outcomes and feasibility of combination chemotherapy using a TA in extremely elderly patients with CRC.

METHODS

Eligibility criteria were: (1) Age above 80 years; (2) Metastatic colorectal cancer; (3) Palliative chemotherapy naïve; (4) Eastern Cooperative Oncology Group performance status 0-1; and (5) Adequate organ function. Patients received at least one dose of combination chemotherapy with or without TA. Response was evaluated every 8 wk.

RESULTS

Of 30 patients, the median age of 15 patients treated with TA was 83.0 years and that of those without TA was 81.3 years. The median progression-free survival (PFS) and overall survival (OS) in patients treated with TA were 7.4 mo and 15.4 mo, respectively, compared with 4.4 mo and 15.6 mo, respectively, in patients treated without TA. There was no significant difference in PFS (P: 0.193) and OS (P: 0.748) between patients treated with and without TA. Common grade 3/4 hematologic toxicities were anemia (16.7%) and neutropenia (10.0%). After disease progression, the median OS of patients who were treated with and without salvage chemotherapy were 23.5 mo and 7.0 mo, respectively, suggesting significant difference in OS (P = 0.001).

CONCLUSION

Combination chemotherapy with TA for metastatic CRC may be considered feasible in patients aged above 80 years, when with careful caution. Salvage chemotherapy can help improve OS in some selected of these elderly patients.

Keywords: Combination chemotherapy; Targeted agent; Colorectal cancer; Salvage chemotherapy; Elderly patient

Core Tip:This study assessed the clinical outcomes of combination chemotherapy and feasibility of target agent (TA) in extremely elderly patients (defined as ≥ 80 years of age) with for metastatic colorectal cancer. The median progression-free survival (PFS) and overall survival (OS) in patients treated with TA were 7.4 mo and 15.4 mo, respectively, compared with 4.4 mo and 15.6 mo, respectively, in patients treated without TA. There was no significant difference in PFS (P: 0.193) and OS (P: 0.748) rates. Targeted therapies may be considered with careful caution even in elderly patients. After disease progression, salvage chemotherapy may help improve OS in some selected of these elderly patients.