Meta-analysis of molecular targeted agents in the treatment of elderly patients with metastatic colorectal cancer: Does the age matter?

Abstract

Patients aged 65 years and older are often underrepresented in clinical trials of metastatic colorectal cancer (mCRC) and probably undertreated in clinical practice. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of molecular targeted agents (MTAs) in this population. A comprehensive literature search for studies published up to December 2014 was performed. The endpoints were overall survival (OS) and progression-free survival (PFS). The pooled hazard ratio (HR) and 95% confidence intervals (CIs) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials. Eleven RCTs involving 8,488 patients were ultimately identified. The pooled analysis demonstrated that the use of MTAs in elderly patients with mCRC significantly improve OS (HR 0.84, 95% CI: 0.76-0.92, P < 0.001) and PFS (HR 0.78, 95% CI: 0.64-0.96, P = 0.017) when compared to MTAs-free therapies. Similar results of OS were observed in subgroup analysis according to treatment line, therapy regimes, and approval status of MTAs. No publication bias was detected by Begg's and Egger's tests. The introduction of MTAs to therapies offered a survival benefit in elderly patients with mCRC. Further studies aimed at this specific patient population were still needed to watchfully monitor potential treatment-related toxicities to optimize the use of these drugs.