AGE AND EFFICACY OF OXALIPLATIN IN COLON CANCER 

J Clin Oncol. 2013 Jun 3. [Epub ahead of print]

Impact of Age on the Efficacy of Newer Adjuvant Therapies in Patients With Stage II/III Colon Cancer: Findings From the ACCENT Database.

McCleary NJ, Meyerhardt JA, Green E, Yothers G, de Gramont A, Van Cutsem E, O'Connell M, Twelves CJ, Saltz LB, Haller DG, Sargent DJ.

Source

Nadine J. McCleary and Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Boston, MA; Erin Green, Michael O'Connell, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Greg Yothers, University of Pittsburgh, Pittsburgh; Daniel G. Haller, University of Pennsylvania, Philadelphia, PA; Aimery de Gramont, Hôpital Saint Antoine, Paris, France; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Christopher J. Twelves, University of Leeds and St James's Institute of Oncology, Leeds, United Kingdom; and Leonard B. Saltz, Memorial Sloan-Kettering Hospital, New York, NY.

Abstract

PURPOSEPrior studies have suggested that patients with stage II/III colon cancer receive similar benefit from intravenous (IV) fluoropyrimidine adjuvant therapy regardless of age. Combination regimens and oral fluorouracil (FU) therapy are now standard. We examined the impact of age on colon cancer recurrence and mortality after adjuvant therapy with these newer options. PATIENTS AND METHODSWe analyzed 11,953 patients age < 70 and 2,575 age ≥ 70 years from seven adjuvant therapy trials comparing IV FU with oral fluoropyrimidines (capecitabine, uracil, or tegafur) or combinations of fluoropyrimidines with oxaliplatin or irinotecan in stage II/III colon cancer. End points were disease-free survival (DFS), overall survival (OS), and time to recurrence (TTR).ResultsIn three studies comparing oxaliplatin-based chemotherapy with IV FU, statistically significant interactions were not observed between treatment arm and age (P interaction = .09 for DFS, .05 for OS, and .36 for TTR), although the stratified point estimates suggested limited benefit from the addition of oxaliplatin in elderly patients (DFS hazard ratio [HR], 0.94; 95% CI, 0.78 to 1.13; OS HR, 1.04; 95% CI, 0.85 to 1.27). No significant interactions by age were detected with oral fluoropyrimidine therapy compared with IV FU; noninferiority was supported in both age populations. CONCLUSIONPatients age ≥ 70 years seemed to experience reduced benefit from adding oxaliplatin to fluoropyrimidines in the adjuvant setting, although statistically, there was not a significant effect modification by age, whereas oral fluoropyrimidines retained their efficacy.