Abstract
PurposeMost metastatic colorectal cancer (mCRC) patients are elderly. This systematic review identifies and describes observational studies evaluating the influence of age on first-line treatment effectiveness in real-world practice.MethodsMedline and EMBASE were searched up to May 2016. The included studies were those that investigated first-line treatment of mCRC and reported age groups and overall survival (OS), progression-free survival (PFS) or overall response rate (ORR) were included. Studies published before 2008 were excluded. Study quality was assessed using the Newcastle–Ottawa Scale. Data were evaluated by age group (< 70 vs. ≥ 70 years; 65–75 vs. ≥ 75 years) and outcome. A pooled survival median was calculated for patients (cutoff = 70 years).ResultsIn total, 11 articles with 11,063 patients were included. Four studies using a cutoff of 70 years of age reported OS and PFS, and two studies reported ORRs. In terms of OS, all studies showed a higher OS for those < 70 years of age than for those ≥ 70 years of age. PFS did not find differences by age. For ORRs, one study favoured the younger group, while the second study did not differ by age. Based on three studies, the pooled medians for < 70 years of age and ≥ 70 years of age were the same for PFS (10.2) and were 27.0 and 22.9 for OS, respectively. All included studies were of high or acceptable quality.ConclusionsThe results suggest that age has no effect on PFS. For ORR, the results were inconsistent between studies. Younger patients in general had better OS, which might be partly explained by more aggressive treatment. This treatment seemed not to be guided by performance status or number of metastatic sites.
Highlights
Colorectal cancer (CRC) is the third most common cancer in men (746,000 cases, 10.0% of the total) and the second most common cancer in women (614,000 cases, 9.2% of the total) (Ferlay et al 2014) worldwide
The population was composed of individuals first diagnosed with metastatic colorectal cancer (mCRC)
The patient age was reported chronologically as the median only (N = 98), the study results were derived from clinical trials (N = 18), the conference abstract had relevant missing information (N = 79), the article was a literature review (N = 28), the article was a systematic review or meta-analysis (N = 7), the same cohort was published in more than one article (N = 5), the study did not include targeted therapies as part of the first-line therapy (N = 1), and the study had untreated patients (N = 1)
Summary
Colorectal cancer (CRC) is the third most common cancer in men (746,000 cases, 10.0% of the total) and the second most common cancer in women (614,000 cases, 9.2% of the total) (Ferlay et al 2014) worldwide. CRC is the second most common cancer in Europe, accounting for 13.0% of all cancers apart from non-melanoma skin cancers. In 2012, there were 214,866 deaths from CRC in Europe (12.2% of the total number of cancer deaths and the second most common cause of cancer-related deaths) (Ferlay et al 2015). The incidence and mortality of CRC increase with age. 67% of CRC patients are aged 65 years and older, and the mortality in this age group is 77% (Ferlay et al 2015). The age of the European population is increasing, with those aged 65 + years estimated to increase from 93.2 million in 2013 to 124.8 million in 2030
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