TY - JOUR
T1 - Oxaliplatin plus fluoropyrimidines as adjuvant therapy for colon cancer in older patients
T2 - A subgroup analysis from the TOSCA trial
AU - TOSCA (Three or Six Colon Adjuvant) Investigators
AU - Rosati, Gerardo
AU - Lonardi, Sara
AU - Galli, Fabio
AU - Di Bartolomeo, Maria
AU - Ronzoni, Monica
AU - Zampino, Maria G
AU - Banzi, Maria
AU - Zaniboni, Alberto
AU - Pasini, Felice
AU - Bozzarelli, Silvia
AU - Garattini, Silvio K
AU - Ferrari, Daris
AU - Montesarchio, Vincenzo
AU - Mambrini, Andrea
AU - Ciuffreda, Libero
AU - Galli, Francesca
AU - Pusceddu, Valeria
AU - Carlomagno, Chiara
AU - Bidoli, Paolo
AU - Amoroso, Domenico
AU - Bochicchio, Anna M
AU - Frassineti, Luca
AU - Corsi, Domenico
AU - Bilancia, Domenico
AU - Pastorino, Alessandro
AU - De Stefano, Alfonso
AU - Labianca, Roberto
N1 - Copyright © 2021 Elsevier Ltd. All rights reserved.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: Previous studies on oxaliplatin and fluoropyrimidines as adjuvant therapy in older patients with stage III colon cancer (CC) produced conflicting results.PATIENTS AND METHODS: We assessed the impact of age on time to tumour recurrence (TTR), disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) in 2360 patients with stage III CC (1667 aged <70 years and 693 ≥ 70 years) randomised to receive 3 or 6 months of FOLFOX or CAPOX within the frame of the phase III, TOSCA study.RESULTS: Older patients compared with younger ones presented more frequently an Eastern Cooperative Oncology Group performance status equal to 1 (10.5% vs 3.3%, p < 0.001), a greater number of right-sided tumours (40.9% vs 26.6%, p < 0.001), and were at higher clinical risk (37.2% vs 33.2%, p = 0.062). The treatments were almost identical in the two cohorts (p = 0.965). We found a greater proportion of dose reductions (46.7% vs 41.4%, p = 0.018), treatment interruptions (26.1% vs 19.3%, p < 0.001) and a higher proportion of recurrences (24.2% vs 20.3%, p = 0.033) in the older patients. The multivariable analysis of the TTR did not indicate a statistically significant effect of age (hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 0.98-1.44; p = 0.082). The HR comparing older with younger patients was 1.34 (95% CI: 1.12-1.59; p = 0.001) for DFS, 1.58 (95% CI: 1.26-1.99; p < 0.001) for OS, and 1.28 (95% CI: 0.96-1.70; p = 0.089) for CSS.CONCLUSIONS: Worse prognostic factors and reduced treatment compliance have a negative impact on the efficacy of oxaliplatin-based adjuvant therapy in older patients.
AB - BACKGROUND: Previous studies on oxaliplatin and fluoropyrimidines as adjuvant therapy in older patients with stage III colon cancer (CC) produced conflicting results.PATIENTS AND METHODS: We assessed the impact of age on time to tumour recurrence (TTR), disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) in 2360 patients with stage III CC (1667 aged <70 years and 693 ≥ 70 years) randomised to receive 3 or 6 months of FOLFOX or CAPOX within the frame of the phase III, TOSCA study.RESULTS: Older patients compared with younger ones presented more frequently an Eastern Cooperative Oncology Group performance status equal to 1 (10.5% vs 3.3%, p < 0.001), a greater number of right-sided tumours (40.9% vs 26.6%, p < 0.001), and were at higher clinical risk (37.2% vs 33.2%, p = 0.062). The treatments were almost identical in the two cohorts (p = 0.965). We found a greater proportion of dose reductions (46.7% vs 41.4%, p = 0.018), treatment interruptions (26.1% vs 19.3%, p < 0.001) and a higher proportion of recurrences (24.2% vs 20.3%, p = 0.033) in the older patients. The multivariable analysis of the TTR did not indicate a statistically significant effect of age (hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 0.98-1.44; p = 0.082). The HR comparing older with younger patients was 1.34 (95% CI: 1.12-1.59; p = 0.001) for DFS, 1.58 (95% CI: 1.26-1.99; p < 0.001) for OS, and 1.28 (95% CI: 0.96-1.70; p = 0.089) for CSS.CONCLUSIONS: Worse prognostic factors and reduced treatment compliance have a negative impact on the efficacy of oxaliplatin-based adjuvant therapy in older patients.
U2 - 10.1016/j.ejca.2021.01.051
DO - 10.1016/j.ejca.2021.01.051
M3 - Article
C2 - 33744715
VL - 148
SP - 190
EP - 201
JO - Eur. J. Cancer
JF - Eur. J. Cancer
SN - 0959-8049
ER -