Abstract
PurposeTreatment advances have improved outcomes in clinical trials of patients with metastatic colorectal cancer (mCRC). Less is known about these effects for patients in real-world settings. This study evaluated treatment patterns and survival in older, demographically diverse patients with mCRC.MethodsA retrospective cohort analysis was performed for 4,250 patients from January 1, 2000 to December 31, 2007 using linked Surveillance, Epidemiology, and End Results-Medicare database. Patients were ≥66 years, enrolled in Medicare parts A and B, and received first-line treatment with fluorouracil and leucovorin (5-FU/LV), capecitabine (CAP), 5-FU/LV plus oxaliplatin (FOLFOX), or CAP and oxaliplatin (CAPOX). Cox regression with backward elimination and propensity score-weighted Cox regression estimated relative risk of death. Date of last follow-up was December 2009. Statistical comparisons were made between 5-FU/LV vs. CAP and FOLFOX vs. CAPOX.ResultsCompared to 5-FU/LV, patients treated with CAP were older (mean age 78 vs. 76; P < 0.0001) and more likely female (61 vs. 54 %; P = 0.0017), while patients receiving CAPOX and FOLFOX were similar in age (mean age 74 vs. 73; P = 0.0924). Complications requiring medical resource utilization following initiation of therapy were significantly higher among patients administered with 5-FU/LV (54 %) vs. CAP (17 %; P < 0.0001) and FOLFOX (75 %) vs. CAPOX (57 %; P < 0.0001). The multivariate analysis revealed no significant differences in survival between 5-FU/LV and CAP and between FOLFOX and CAPOX.ConclusionsOverall survival was comparable between CAP and 5-FU/LV and between CAPOX and FOLFOX with fewer complications requiring medical resource utilization associated with CAP and CAPOX, thus confirming clinical trial results.Electronic supplementary materialThe online version of this article (doi:10.1007/s12029-012-9450-x) contains supplementary material, which is available to authorized users.
Highlights
Colorectal cancer (CRC) is a disease of the elderly with a median age at diagnosis of 70 years and median age at death of 75 years [1]
Overall survival was comparable between CAP and 5-FU/LV and between CAP and oxaliplatin (CAPOX) and FOLFOX with fewer complications requiring medical resource utilization associated with CAP and CAPOX, confirming clinical trial results
A higher proportion of patients treated with CAPOX were older and had stage IV disease compared with those treated with FOLFOX
Summary
Colorectal cancer (CRC) is a disease of the elderly with a median age at diagnosis of 70 years and median age at death of 75 years [1]. It is the third most frequently diagnosed cancer as well as the third leading cause of cancer mortality in men and women in the USA [2]. For the past 50 years, the mainstay of systemic treatment for advanced or metastatic CRC (mCRC) has been fluoropyrimidines (FP) administered as monotherapy or in combination with leucovorin (LV) or newer agents such as irinotecan (IFL) and oxaliplatin [3, 4]. Randomized controlled trials have established the efficacy of 5-FU/LV plus oxaliplatin (FOLFOX) with significant improvements in RR and progression-free survival (PFS) when administered as first-line therapy for patients with advanced CRC [6]
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