Abstract
BackgroundThe aim of this meta-analysis was to evaluate efficacy and safety of first-line chemotherapy with or without a monoclonal antibody in elderly patients (≥ 70 years) with metastatic colorectal cancer (mCRC), since they are frequently underrepresented in clinical trials.ResultsIndividual data from 10 studies were included. From a total of 3271 patients, 604 patients (18%) were ≥ 70 years (median 73 years, range 70–88). Of these, 335 patients were treated with a bevacizumab-based first-line regimen and 265 were treated with chemotherapy only. The median PFS was 8.2 vs. 6.5 months and the median OS was 16.7 vs. 13.0 months in patients treated with and without bevacizumab, respectively. The safety profile of bevacizumab in combination with first-line chemotherapy did not differ from published clinical trials.Materials and MethodsPubMed and Cochrane Library searches were performed on 29 April 2013 and studies published to this date were included. Authors were contacted to request progression-free survival (PFS), overall survival (OS) data, patient data on treatment regimens, age, sex and potential signs of toxicity in patients ≥ 70 years of age.ConclusionsThis meta-analysis suggests that the addition of bevacizumab to standard first-line chemotherapy improves clinical outcome in elderly patients with mCRC and is well tolerated.
Highlights
Colorectal cancer (CRC) is one of the most common cancers worldwide with over 1,300,000 new cases each year [1]
335 patients were treated with a bevacizumab-based first-line regimen and 265 were treated with chemotherapy only
The safety profile of bevacizumab in combination with first-line chemotherapy did not differ from published clinical trials
Summary
Colorectal cancer (CRC) is one of the most common cancers worldwide with over 1,300,000 new cases each year [1]. Survival benefit with standard chemotherapy regimens has been shown to be similar for mCRC patients ≥ 70 years of age compared with those < 70 years, and there is no marked difference in tolerability profiles [3]. As a result of this, findings from colorectal clinical trials do not necessarily fully reflect real-life experience as the proportion of elderly patients is low and any subgroup analysis evaluating treatment efficacy in elderly patients from a single trial is difficult to perform with sufficient power because of this low number of patients. Metaanalysis of a number of similar clinical trials is an option to allow analysis of a sufficient amount of clinical data The aim of this meta-analysis was to evaluate efficacy and safety of first-line chemotherapy with or without a monoclonal antibody in elderly patients ( ≥ 70 years) with metastatic colorectal cancer (mCRC), since they are frequently underrepresented in clinical trials
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