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A B S T R A C T S
S41
P009
OUTCOME AND AGE DEPENDENT DIFFERENCES IN CHOICE
OF ADJUVANT CHEMOTHERAPY IN PATIENTS WITH
PRIMARY COLORECTAL CANCER (THE ACCORE STUDY)
C. Lund
1,
*, D. Nielsen
2
, C. Dehlendorff
3
, F. Rønholt
1
,
A. B. Christiansen
2
, J. S. Johansen
2
, K. K. Vistisen
2
1
Department of Medicine,
2
Department of Oncology, Copenhagen
University Hospital, Herlev,
3
Danish Cancer Society Research
Center, Danish Cancer Society, Copenhagen, Denmark
Introduction:
Elderly patients withprimary colorectal
cancer (CRC) are less frequently treated with adjuvant chemo-
therapy than younger patients due to concerns on toxicity
and efficiency [1-3].
Objectives:
We wanted to investigate how age, performance
status (PS) and comorbidity influence choice of treatment and
outcomes.
Methods:
A retrospective single center study of 529 patients
operated for stage II-III CRC and treated with adjuvant
chemotherapy (5-fluorouracil/capecitabine ± oxaliplatin) in
2001-2011 at Herlev University Hospital, Denmark. Baseline
characteristics, chemotherapy and outcome were analyzed
with respect to age while adjusting for PS and comorbidity.
Results:
Elderly patients (
70 years) had significant more
comorbidity (
p
<0.001) and poorer PS (
p
=0.001) than younger
patients. Elderly were more frequently treated with single
agent therapy (
p
=0.001) and at lower initial dose (
p
<0.001).
There was no age-dependent difference in 3-year disease free
survival (DFS) (hazard ratio (HR) 1.09, 95% confidence interval
(Cl) 0.80-1.47,
p
=0.59), in grade 3-5 toxicity (29% vs.28%,
p
=0.86)
or in ten-years CRC mortality (28% for both groups, HR 1.07,
P
=0.71). For elderly patients a reduction in chemotherapy dose
intensity compared to full dose had no impact on DFS or CRC
mortality. Elderly patients receiving <50% of planned cycles
had shorter DFS (HR=1.78,
p
=0.020) and higher CRC mortality
(HR=2.17,
p
=0.027) compared to elderly receiving all cycles.
Poor PS in both younger and elderly patients was related to
shorter DFS (<70: HR=1.95,
p
=0.002;
70: HR=1.60,
p
=0.035) and
OS (<70: HR=2.28,
p
<0.001;
70: HR=2.03,
p
=0.002). Comorbidity
in younger patients was significantly related to shorter DFS
(HR 2.72,
p
<0.001), OS (HR 3.16,
p
<0.001) and higher CRC
mortality (HR 2.70,
p
=0.001).
Conclusion:
Choice of regimen, primary dose reduction,
and given dose intensity in patients treated with adjuvant
chemotherapy after operation for CRC were highly dependent
on age. However, age had no impact on DFS and CRC mortality.
Comorbidity in younger patients and PS in all patients were
associated with shorter DFS and higher CRC mortality.
References:
[1] Sanoff HK, et al. Effect of adjuvant chemotherapy on
survival of patients with stage III colon cancer diagnosed
after age 75 years. J Clin Oncol 2012;30:2624-2634.
[2] Hermosillo-Rodriguez J, et al. The effect of age and
comorbidity on patient-centered health outcomes in
patients receiving adjuvant chemotherapy for colon
cancer. J Geriatr Oncol 2013;4:99-106.
[3] Papamichael D, et al. Treatment of colorectal cancer in
older patients: International Society of Geriatric Oncology
(SIOG) consensus recommendations 2013. Ann Oncol 2014.
Disclosure of interest:
None declared
Keywords:
Adjuvant chemotherapy, colorectal cancer,
comorbidity, elderly, performance status
P010
A PROSPECTIVE NON-INTERVENTIONAL STUDY ON
THE USE OF BEVACIZUMAB AND CONVENTIONAL
CHEMOTHERAPY FOR FIRST LINE ELDERLY PATIENTS WITH
METASTATIC COLORECTAL CANCER (MCRC): TREATMENT
DURATION AND TOXICITY
C. Kenis
1,
*, L. Decoster
2
, H. Wildiers
1
, G. Houbiers
3
,
B. Naessens
4
, M. De Man
5
, G. Lambrecht
6
, E. Monsaert
7
,
V. Moons
8
, P. Vergauwe
9
, H. Prenen
1
, L. Opstaele
10
,
E. Van De Walle
11
, E. Van Cutsem
1
1
UZ Leuven, Leuven,
2
UZ Brussels, Brussels,
3
CHC Clinique
St Joseph, Liege,
4
AZ Nikolaas, St.Niklaas,
5
OLV Aalst,
Gent,
6
AZ Damiaan, Oostende,
7
AZ Maria Middelares, Gent,
8
Imeldaziekenhuis, Bonheide,
9
AZ Groeninge, Kortrijk,
10
Innosens,
11
Roche NV/SA, Brussels, Belgium
Introduction:
58% of all Belgian CRC patients are
70 years.
In randomized clinical trials, only medically fit patients
are included. Choosing the most appropriate therapy in
the heterogenic older population is increasingly complex.
Geriatric screening and assessment (GA) allow evaluation of
individual global health status and subsequently optimisation
of oncological treatment decisions. This observational study
aims to complement the knowledge on chemotherapy and
bevacizumab usage in older patients.
Objectives:
The primary objective of the current study
was treatment duration of first line bevacizumab containing
chemotherapy. Treatment duration of conventional chemo-
therapy, safety of bevacizumab in elderly and correlation of
baseline geriatric screening and GAwere secondary objectives.
Methods:
This was a national, multicentre, prospective,
non-interventional, post-authorization study. Patients
70
years with untreated mCRC, considered suitable to receive
chemotherapy with or without bevacizumab were eligible
for inclusion. Dosing and treatment were at the discretion of
the investigator. In this observational study progression free
survival (PFS) assessments were not carried out at protocol
pre-specified fixed intervals and were not independently
assessed.
Results:
Between August 2011 and July 2013, 34 Belgian
centres included a total of 252 patients in the safety population
(SA). The reference population (REF) consists of 250 patients
with efficacy data. Geriatric screening and GA results are
presented in separate publications.
Median treatment duration, defined as the time between
the first, first-line mCRC cancer treatment administration
and the last, first line mCRC cancer treatment administration,
in the SA population was 6.5 (5.5-7.4) months and 4.8
(3.8-5.5) months (p=0.0002) in bevacizumab containing and
conventional chemotherapy respectively. Median PFS in the
REF population was 9.2 (8.0-11.2) and 8.7 (6.9-9.8) months in
bevacizumab and conventional chemotherapy respectively