NEW YORK (Reuters Health) Jul 29 - In adults over age 65 with stage II colon cancer and high-risk clinical features, adjuvant chemotherapy likely won't improve survival, a new "real world" study shows.
Survival benefits are generally less than 2% at five years, the study investigators say.
"This lack of benefit must be considered in treatment decisions for similar older adults with colon cancer," said Dr. Erin S. O'Connor and colleagues from the University of Wisconsin in Madison in the Journal of Clinical Oncology.
In their paper, published online July 25th, Dr. O'Connor and colleagues note that adjuvant chemotherapy is typically considered for patients with stage II colon cancer and such poor prognostic features as obstruction, perforation, T4 stage, inadequate nodal resection, peritumoral lymphatic/venous invasion, and poor histology.
Yet there is no evidence that these characteristics, although associated with worse outcomes, predict a good response to adjuvant chemotherapy.
Using the Surveillance, Epidemiology and End Results (SEER) database, Dr. O'Connor's team determined the overall survival benefit of adjuvant chemotherapy in 43,032 Medicare beneficiaries who had colectomy for colon cancer.
The cohort consisted of 6,234 patients with stage II disease but no poor prognostic features, 18,613 with stage II cancer and at least one poor prognostic factor, and 18,185 with stage III disease.
Overall, about 20% of the 24,847 patients with stage II colon cancer received adjuvant chemotherapy, with no difference between risk groups. As expected, survival at five years was significantly lower in stage II patients with poor prognostic features (57%, vs. 69% in those without poor prognostic features).
According to the investigators, adjuvant chemotherapy failed to improve survival in patients with stage II disease, regardless of the presence or absence of poor prognostic features (hazard ratios 1.03 and 1.02, respectively).
A survival benefit from adjuvant chemotherapy was observed only in patients with stage III disease (hazard ratio 0.64), 57% of whom received adjuvant therapy.
In a commentary, Dr. Neal Meropol from University Hospitals Seidman Cancer Center in Cleveland, Ohio said this analysis "should discourage routine use" of adjuvant treatment in older patients with stage II colon cancer.
But, he noted, it does not exclude a potential benefit of adjuvant treatment in patients younger than age 65.
SOURCE: http://bit.ly/njs5mv
J Clin Oncol 2011.
Survival benefits are generally less than 2% at five years, the study investigators say.
"This lack of benefit must be considered in treatment decisions for similar older adults with colon cancer," said Dr. Erin S. O'Connor and colleagues from the University of Wisconsin in Madison in the Journal of Clinical Oncology.
In their paper, published online July 25th, Dr. O'Connor and colleagues note that adjuvant chemotherapy is typically considered for patients with stage II colon cancer and such poor prognostic features as obstruction, perforation, T4 stage, inadequate nodal resection, peritumoral lymphatic/venous invasion, and poor histology.
Yet there is no evidence that these characteristics, although associated with worse outcomes, predict a good response to adjuvant chemotherapy.
Using the Surveillance, Epidemiology and End Results (SEER) database, Dr. O'Connor's team determined the overall survival benefit of adjuvant chemotherapy in 43,032 Medicare beneficiaries who had colectomy for colon cancer.
The cohort consisted of 6,234 patients with stage II disease but no poor prognostic features, 18,613 with stage II cancer and at least one poor prognostic factor, and 18,185 with stage III disease.
Overall, about 20% of the 24,847 patients with stage II colon cancer received adjuvant chemotherapy, with no difference between risk groups. As expected, survival at five years was significantly lower in stage II patients with poor prognostic features (57%, vs. 69% in those without poor prognostic features).
According to the investigators, adjuvant chemotherapy failed to improve survival in patients with stage II disease, regardless of the presence or absence of poor prognostic features (hazard ratios 1.03 and 1.02, respectively).
A survival benefit from adjuvant chemotherapy was observed only in patients with stage III disease (hazard ratio 0.64), 57% of whom received adjuvant therapy.
In a commentary, Dr. Neal Meropol from University Hospitals Seidman Cancer Center in Cleveland, Ohio said this analysis "should discourage routine use" of adjuvant treatment in older patients with stage II colon cancer.
But, he noted, it does not exclude a potential benefit of adjuvant treatment in patients younger than age 65.
SOURCE: http://bit.ly/njs5mv
J Clin Oncol 2011.
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