Efficacy and safety of bevacizumab in elderly patients with metastatic colorectal cancer: results from the Czech population-based registry

Lubomir Slavicek,Ladislav Dusek,Jiri Tomasek,Zbynek Bortlicek,Bohuslav Melichar,Tomas Pavlik,Ondrej Majek,Rostislav Vyzula,Jindrich Finek,Jana Prausova,Tomas Buchler

doi:10.1186/1471-230x-14-53

Abstract

BackgroundPatients aged 65 years and older represent the majority of patients with metastatic colorectal cancer (mCRC). However, this patient population is often underrepresented in clinical trials and probably undertreated in the clinical practice.MethodsWe have analysed the outcomes of 3,187 mCRC patients treated with first-line bevacizumab based on data from the Czech national registry of mCRC patients aiming to compare the treatment efficacy and safety according to the age categories.ResultsIn total, 2,126 (66.7%), 932 (29.2%), and 129 (4.0%) patients were aged <65 years, 65 to 75 years, and 75+ years, respectively. Median progression-free survival (PFS) was 11.4, 11.3, and 11.8 months for patients aged <65 years, 65 to 75 years, and 75+ years, respectively (p = 0.94). Median overall survival (OS) was 26.9, 27.5, and 25.1 months for patients aged <65 years, 65 to 75 years, and 75+ years, respectively (p = 0.73). Using multivariable Cox model for both PFS and OS, the patient age was not significantly associated with either PFS or OS. No increase in bevacizumab-related toxicity was observed among the elderly mCRC patients with the exception of hypertension, which was observed in 71 (3.3%), 34 (3.6%), and 10 (7.8%) patients aged <65 years, 65 to 75 years, and 75+ years, respectively.ConclusionsThe results of the present study suggest similar outcome in terms of OS and PFS with bevacizumab-containing therapy in elderly mCRC patients fit for chemotherapy combined with targeted therapy compared to younger patients. Thus, chronological age should not be considered to represent a limitation in prescribing bevacizumab-containing therapy in mCRC patients.

Highlights

Patients aged 65 years and older represent the majority of patients with metastatic colorectal cancer
The results of recently published randomised trials as well as observational studies [12,13,14,15] suggest that bevacizumab provides similar overall survival (OS) and progression-free survival (PFS) benefits in patients aged ≥65 years compared to younger patients
In total, 3,187 metastatic colorectal cancer (mCRC) patients treated with first-line bevacizumab were analysed

Summary

Introduction

Patients aged 65 years and older represent the majority of patients with metastatic colorectal cancer (mCRC). This patient population is often underrepresented in clinical trials and probably undertreated in the clinical practice. The introduction of new cytotoxic drugs, targeted therapy, and an increase in patient population is often underrepresented in clinical trials and very likely undertreated in the clinical practice [10,11]. We have analysed the data from the Czech national registry of mCRC patients treated with first-line bevacizumab with the aim to compare the treatment outcomes according to age The results of recently published randomised trials as well as observational studies [12,13,14,15] suggest that bevacizumab provides similar overall survival (OS) and progression-free survival (PFS) benefits in patients aged ≥65 years compared to younger patients.

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Results

Discussion

Conclusion