162P - Real world use of palliative systemic therapy (tx) in elderly patients (pts) with metastatic colorectal cancer (mCRC) within a UK specialist cancer centre

Abstract

Background: Given our ageing population, in mCRC, we are increasingly faced with the challenge of treating elderly pts. Real world evidence relating to the efficacy and tolerability of systemic tx in this specific group is lacking. Methods: Retrospective analysis of pts with mCRC age>70, treated with systemic tx at Royal Marsden Hospital (RMH) between Jan 2009 – Dec 2014 was conducted. Results: Out of 134 pts presenting with mCRC, 63% were male, median age 77 (range 70-94). 18% had performance status (PS) 0, 55% PS 1, 22% PS 2, 5% PS ≥ 3. 40% of pts had no comorbidities listed in the Charlson comorbidities index (CCI), whereas 23% had ≥2. 10% of pts did not take any concomitant medication (con mx), whereas 34% took ≥5. 72% of pts lived with family, 25% alone, 1% in a nursing home and 2% unknown. 71% had left-sided tumours. 73% had liver, 34% lung and 13% peritoneal metastases. From 82 pts with known KRAS status, 41% were mutant. When including pts with a recurrence that had palliative systemic tx (n = 163), the most commonly prescribed tx were: 18% CAPOX, 12% FOLFIRI, 11% capecitabine or 5FU alone and 9% FOLFIRI+Bevacizumab. Across all lines of tx 44% required ≥1 week tx delay. In 46% of cases a dose reduction or drug discontinuation in combination tx was required. Median overall survival (mOS) for pts presenting with mCRC was 16.7 months (95% C.I=13.7-20.7). Pts that had sequential systemic tx had a significant OS benefit, p < 0.005 (table). Poor PS and more con mx predicted for a statistically lower mOS (p < 0.005). Primary tumour location, KRAS status, social circumstances and number of comorbidities listed in CCI had no significant impact on mOS.Table: 162PMetastatic tx line1234N163823916Median PFS, months7.34.85.42.7Best response (%)CR 2 PR 33 SD 24 PD 27 NA 14CR 1 PR 27 SD 24 PD 34 NA 14CR 0 PR 23 SD 23 PD 39 NA 15CR 0 PR 13 SD 25 PD 31 NA 31mOS from diagnosis if last line of tx: months10.818.135.840.3 Open table in a new tab Conclusions: A significant number of older pts have no or few comorbidities and a good PS. These pts benefit from sequential systemic tx, including standard combination tx. Close supervision during tx is imperative, given the high rate of tx modifications. More real life data is needed to bridge the gap of the under-representation of elderly pts in clinical trials. Legal entity responsible for the study: Royal Marsden Hospital Funding: None Disclosure: All authors have declared no conflicts of interest.