Abstract

e19668 Background: Randomized controlled trials suggest similar efficacy and tolerance of chemotherapy in elderly cancer patients compared to younger. The objective was to assess in real-world setting FOLFOX4 relative dose intensity (RDI) and identify factors associated with dose reduction or stop. Methods: Between January 2007 and February 2010, 86 consecutive patients with colorectal cancer treated by FOLFOX4 were included and followed for first dose reduction (≥15%) or stop during 12 cycles for adjuvant chemotherapy (n=58) and 6 cycles for palliative chemotherapy (n=28). Data regarding patient characteristics and doses were collected using hospital chemotherapy database. Among a subgroup of patients ≥ 70 years, Comprehensive Geriatric Assessment parameters were assessed. Analysis used Kaplan-Meier survival curves, log-rank tests and Cox model. Results: Mean age was 65.3 (±11.5; 44.2% ≥ 70 years), 52.3% were women and 54.4% had a performance status (PS) at 0. Median RDI was 0.89 (Q1: 0.74 – Q3: 0.97). Respectively for FOLFOX4, 5FU and oxaliplatine, 48.4% (95% CI: 35.6-63), 26.7% (12-44.8) and 47.2% (37-61) had a dose reduction or stop within 3 months. Age ≥ 70 years (p logrank=0.007), female sex (p=0.03) and PS of 1 or more (p=0.03) were associated with dose reduction or stop. In multivariate analysis, female sex (adjusted HR = 2.34; 95%CI:1.04-5.57) and age (adjusted HR for one year increase = 1.04; 95% CI:1.00-1.09) remained associated with dose reduction or stop. Neuro-and hematotoxicity were the leading causes of dose reduction or stop of oxaliplatine (48.9%) and 5FU (38.5%) respectively. Patients ≥ 70 years had more often neurotoxicity related to oxaliplatine (46.4% vs 14.8%; p=0.003) than younger whereas no significant difference was found for 5FU. Dependency (adjusted HR=7.35; 95% CI:1.19-45.5; p=0.03) and impaired mobility (6.18; 95%CI:1.16-33.07; p=0.033) were associated with dose reduction or stop after adjustment for age. Conclusions: age was independently associated with FOLFOX4 dose reduction or stop. This can be partly explained by a greater toxicity in elderly for oxaliplatine but not for 5FU. Among elderly, dependency and impaired mobility may be associated with FOLFOX4 dose reduction or stop.

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