Palliative chemotherapy in advanced colorectal cancer patients 80 years of age and older
Colorectal cancer (CRC) has a median diagnostic age of 68 years. Despite significant progress in chemotherapy (CTX) options, few data on outcomes or toxicity from ctx in patients 80 years of age and older are available. We investigated CTX in such patients with metastatic CRC (MCRC), hypothesizing high rates of hospitalization and toxicity.
A retrospective chart review identified patients 80 years of age and older with MCRC who initiated CTX between 2005–2010 at our institution. Patient demographics and CTX data were collected. Endpoints included rates of hospitalization, CTX discontinuation because of toxicity, and overall survival.
In 60 patients, CTX was initiated on 88 occasions. Median age in the cohort was 83 years; 52% were men; 72% lived with family; 53% had a modified Charlson comorbidity index of 2 or greater; and 31% were taking 6 or more prescription medications at baseline. At baseline, 33% of the patients were anemic (hemoglobin < 100 g/L), 36% had leukocytosis (white blood cells > 11×109/L), and 48% had renal impairment (estimated glomerular filtration rate < 60 mL/min/1.73 m2). In 53%, CTX was given as first-line treatment. The initial CTX dose was adjusted in 67%, and capecitabine was the most common chemotherapeutic agent (45%). In 19 instances (22%), the patient was hospitalized during or within 30 days of CTX; in 26 instances (30%), the CTX was discontinued because of toxicity, and in 48 instances (55%), the patient required at least 1 dose reduction, omission, or delay. Median overall survival was 17.8 months (95% confidence interval: 14.3 to 20.8 months).
In the population 80 years of age and older, CTX for MCRC is feasible; however, most recipients will require dose adjustments, and a significant proportion will be hospitalized or stop CTX because of toxicity. Prospective research incorporating geriatric assessment tools is required to better select these older patients for CTX.