Older Adults Are Less Likely to Receive Second-Line Therapy for Metastatic Colorectal Cancer, Study Reports

The following article features coverage from the 2020 Gastrointestinal Cancers Symposium meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

Older adults (OAs) and patients with an Eastern Cooperative Oncology Group (ECOG) performance status higher than 1 were less likely than their younger peers to receive second-line therapy for metastatic colorectal cancer (mCRC), an analysis of 10 first-line trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) Clinical Trials Program revealed.

The review included an examination of 5289 patients from the database of trials in advanced colorectal cancer to see if there were differences in the receipt of second-line therapies between older adults and younger adults with mCRC following disease progression. Among these patients, 16.4% were classified as older adults.

The investigators also compared time to initial progression (TTiP), time to progression, and overall survival across groups, adjusting for age, sex, ECOG performance status, the number of metastatic sites present, as well as for the evidence of metastatic lesions in the lungs, liver, or peritoneum.

The odds of receiving second-line therapy for mCRC differed based on patient age; younger adults were more likely than their older peers to receive a subsequent therapy after disease progression following frontline therapy. In fact, results of a multivariate analysis revealed that the “odds of receiving second-line therapy decreased by 11% for each additional decade of life” (P =.0117).

However, even though the odds of receiving a second treatment were higher for younger patients compared with older patients, the higher frequency of receipt of later-line medication did not appear to meaningfully influence large differences in median TTP (5.2 months vs 5.1 months, respectively) nor mean overall survival (12.4 months vs 11.6 months, respectively) between patients subsets.

The authors noted that future research should examine the influence of factors such as patient comorbidity and functional status on survival outcomes, and researchers should consider incorporating a geriatric assessment tool to guide the selection of older adults who would be most likely to benefit from second-line therapy in mCRC.

Disclosure: This study was funded by the National Cancer Institute at the National Institutes of Health’s Gastrointestinal Specialized Programs of Research Excellence (SPORE) and Dana–Farber/Harvard Cancer Center.

Read more of Cancer Therapy Advisor‘s coverage of the ASCO GI annual meeting by visiting the conference page.

Reference

McCleary NJ, Harmsen WS, VanCutsem E, et al. Receipt and survival outcomes by age following second-line therapy for metastatic CRC (mCRC): Analysis of 5,289 patients from the ARCAD Clinical Trials Program. J Clin Oncol. 2020;38(suppl 4):Abstract 6.