Abstract
e14056 Background: The NCCN guidelines for stage 4 colon cancer (CC4) patients provide general guidance on which chemotherapies and targeted therapies improve survival or quality of life but do not provide specific treatment (TX) recommendations. The guidelines suggest that TX is highly individualized and no single treatment is right for everyone. This leads to variation in both the number and types of TX lines, especially for elderly patients where there are larger evidence gaps. Methods: Elderly (65+) SEER-Medicare patients diagnosed with CC4 in 2003-2007 were followed through death or 2009 to examine variation across sub-groups in the number of TX lines. TX included 5-fluorouracil and (levo)leucovorin-based (5FU/LV); irinotecan (IRI) and/or oxaliplatin (OX) with/out 5FU/LV; bevacizumab, cetuximab, or panitumumab (MNCLA), alone or in combination with chemotherapy; and other TX. A hierarchy categorized treatments as: 1) IROX (IRI+OX); 2) IRI or OX; 3) 5FU/LV; 4) MNCLA without chemotherapy; and 5) other TX. Gaps in TX or changes from OX or IRI to 5FU/LV were not considered new lines. Results: Of 3,263 CC4 patients who received TX, 98% started with an NCCN-approved TX for colon cancer and 1,541 (47%) went on to second line TX. Among those with at least 2 lines of TX, the most common sequences of TX lines were OX to IRI (42%), IRI to OX (12%), 5FU/LV to OX (11%) and 5FU/LV to IRI (11%). Approximately 17% switched from chemotherapy to MNCLA alone and relatively few ever used IROX. Of second line patients, 570 (37%) had a third line of treatment. The most frequent sequence for 3 TX lines were OX to IRI to MNCLA alone (30%); 5FU/LV to OX to IRI (12%); and OX to MNCLA alone to IRI (11%). Conclusions: The number of TX lines and the sequence of TX regimens vary considerably across elderly CC4 patients. Almost all patients started with an NCCN-approved TX for colon cancer. OX to IRI for first and second line TX was the most common sequence.
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