Single-agent capecitabine use in patients age 70 or older with colorectal cancer.

Abstract

764 Background: Colorectal cancer (CRC) is primarily a disease of the elderly, with a median age at diagnosis of 71. Administration of chemotherapy treatment in elderly patients with CRC is challenging due to multiple factors, including co-morbidities and a decline in organ function and is often associated with more toxicities and hospitalisations. Capecitabine monotherapy is an effective treatment in CRC but is associated with toxicities, commonly necessitating dose reduction (DR) in elderly patients. We present an audit of capecitabine prescribing in patients with CRC over the age of 70. Methods: The medical records of 43 patients over 70 receiving capecitabine monotherapy for CRC in our unit between November 2012 and August 2014 were analysed. The starting dose of capecitabine was established, and dose reductions prior to initial treatment were noted. Subsequent dose reductions, and toxicities necessitating such reductions were recorded. Results: 74 patients (37 male;37 female) were treated, 47 adjuvantly and 27 palliatively. The median age at treatment was 78. Patients received an average of 4.3 cycles (range 1-8), at an average starting dose of 1800mg (range 1000-2700mg). 43/74 (58%) patients received a DR from 1250mg/m2, prior to cycle one, with an average DR of 22% (range 0%-60%). The primary reason for DR was frailty (62%), inadequate GFR (35%), and poor performance status (3%). Secondary reasons included ischaemic heart disease and other comorbidities. 12/43 (28%) patients required a DR at subsequent cycles, due to diarrhoea (50%), fatigue (33%) and PPE (17%). 3/43 (7%) patients terminated their treatment early due to angina, PPE and diarrhoea respectively. 2/27 (9%) metastatic patients received capecitabine (625mg/m2) in combination with bevacizumab. Conclusions: Real-life dosing of capecitabine in the over 70’s, selected as fit but frail is more conservative than the guidelines recommend and was associated with considerable toxicity precluding dose escalation. Even at reduced starting doses toxicity was substantial and a third required a further dose reduction which questions the efficacy of adjuvant chemotherapy in this age group, despite a proactive education patient programme about diarrhoea and PPE.