Management of metastatic colorectal cancer in patients ≥70 years - a single center experience

Florian Huemer; Celine Dunkl; Gabriel Rinnerthaler; Konstantin Schlick; Ronald Heregger; Klaus Emmanuel; Daniel Neureiter; Eckhard Klieser; Michael Deutschmann; Falk Roeder; Richard Greil; Lukas Weiss

doi:10.3389/fonc.2023.1222951

Management of metastatic colorectal cancer in patients ≥70 years - a single center experience

Front Oncol. 2023 Jul 25:13:1222951. doi: 10.3389/fonc.2023.1222951. eCollection 2023.

Authors

Florian Huemer¹, Celine Dunkl¹, Gabriel Rinnerthaler^{1

2}, Konstantin Schlick¹, Ronald Heregger¹, Klaus Emmanuel³, Daniel Neureiter^{2

4}, Eckhard Klieser⁴, Michael Deutschmann⁵, Falk Roeder⁶, Richard Greil^{1

2

7}, Lukas Weiss^{1

2

7}

Affiliations

¹ Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria.
² Cancer Cluster Salzburg, Salzburg, Austria.
³ Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria.
⁴ Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria.
⁵ Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria.
⁶ Department of Radiation Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria.
⁷ Tumor Registry of the Province of Salzburg, Salzburg, Austria.

Abstract

Background: Age-standardized mortality rates for metastatic colorectal cancer (mCRC) are highest among elderly patients. In current clinical guidelines, treatment recommendations for this patient population are based on a limited number of clinical trials.

Patients and methods: In this monocentric, retrospective analysis we characterized patients aged ≥70 years undergoing systemic therapy for mCRC and overall survival (OS) was investigated.

Results: We included 117 unselected, consecutive mCRC patients aged ≥70 years undergoing systemic therapy for mCRC between February 2009 and July 2022. Median OS was 25.6 months (95% CI: 21.8-29.4). The median age was 78 years (range: 70-90) and 21%, 48%, 26% and 5% had an ECOG performance score of 0, 1, 2, and 3, respectively. The median number of systemic therapy lines was 2 (range: 1-5). The choice of first-line chemotherapy backbone (doublet/triplet versus mono) did not impact OS (HR: 0.83, p=0.50) or the probability of receiving subsequent therapy (p=0.697). Metastasectomy and/or local ablative treatment in the liver, lung, peritoneum and/or other organs were applied in 26 patients (22%) with curative intent. First-line anti-EGFR-based therapy showed a trend towards longer OS compared to anti-VEGF-based therapy or chemotherapy alone in left-sided mCRC (anti-EGFR: 39.3 months versus anti-VEGF: 27.3 months versus chemotherapy alone: 13.8 months, p=0.105). In multivariable analysis, metastasectomy and/or local ablative treatment with curative intent (yes versus no, HR: 0.22, p<0.001), the ECOG performance score (2 versus 0, HR: 3.07, p=0.007; 3 versus 0, HR: 3.66, p=0.053) and the presence of liver metastases (yes versus no, HR: 1.79, p=0.049) were independently associated with OS.

Conclusions: Our findings corroborate front-line monochemotherapy in combination with targeted therapy as the treatment of choice for elderly mCRC patients with palliative treatment intent. Metastasectomy and/or local ablative treatment with curative intent are feasible and may improve OS in selected elderly mCRC patients.

Keywords: ECOG performance score; age; colorectal cancer; elderly; local ablative treatment; metastasectomy; sidedness.

Grants and funding

This work was supported by Servier Austria GmbH without any role in the design of the analysis, interpretation of data or influence on the content of the manuscript.