Background: Previous studies on oxaliplatin and fluoropyrimidines as adjuvant therapy in older patients with stage III colon cancer (CC) produced conflicting results. Patients and methods: We assessed the impact of age on time to tumour recurrence (TTR), disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) in 2360 patients with stage III CC (1667 aged <70 years and 693 ≥ 70 years) randomised to receive 3 or 6 months of FOLFOX or CAPOX within the frame of the phase III, TOSCA study. Results: Older patients compared with younger ones presented more frequently an Eastern Cooperative Oncology Group performance status equal to 1 (10.5% vs 3.3%, p < 0.001), a greater number of right-sided tumours (40.9% vs 26.6%, p < 0.001), and were at higher clinical risk (37.2% vs 33.2%, p = 0.062). The treatments were almost identical in the two cohorts (p = 0.965). We found a greater proportion of dose reductions (46.7% vs 41.4%, p = 0.018), treatment interruptions (26.1% vs 19.3%, p < 0.001) and a higher proportion of recurrences (24.2% vs 20.3%, p = 0.033) in the older patients. The multivariable analysis of the TTR did not indicate a statistically significant effect of age (hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 0.98–1.44; p = 0.082). The HR comparing older with younger patients was 1.34 (95% CI: 1.12–1.59; p = 0.001) for DFS, 1.58 (95% CI: 1.26–1.99; p < 0.001) for OS, and 1.28 (95% CI: 0.96–1.70; p = 0.089) for CSS. Conclusions: Worse prognostic factors and reduced treatment compliance have a negative impact on the efficacy of oxaliplatin-based adjuvant therapy in older patients.

Oxaliplatin plus fluoropyrimidines as adjuvant therapy for colon cancer in older patients: A subgroup analysis from the TOSCA trial

Pasini F.;Ciuffreda L.;Rosati G.;Aprile G.;Pasini F.;Romiti A.;Ciuffreda L.;Mosconi S.;Allione P.;Cascinu S.;Testore F.;Gori S.;Aglietta M.;Ballestrero A.;Leonardi F.;Amadori D.;Poli D.;Porcu L.;
2021

Abstract

Background: Previous studies on oxaliplatin and fluoropyrimidines as adjuvant therapy in older patients with stage III colon cancer (CC) produced conflicting results. Patients and methods: We assessed the impact of age on time to tumour recurrence (TTR), disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) in 2360 patients with stage III CC (1667 aged <70 years and 693 ≥ 70 years) randomised to receive 3 or 6 months of FOLFOX or CAPOX within the frame of the phase III, TOSCA study. Results: Older patients compared with younger ones presented more frequently an Eastern Cooperative Oncology Group performance status equal to 1 (10.5% vs 3.3%, p < 0.001), a greater number of right-sided tumours (40.9% vs 26.6%, p < 0.001), and were at higher clinical risk (37.2% vs 33.2%, p = 0.062). The treatments were almost identical in the two cohorts (p = 0.965). We found a greater proportion of dose reductions (46.7% vs 41.4%, p = 0.018), treatment interruptions (26.1% vs 19.3%, p < 0.001) and a higher proportion of recurrences (24.2% vs 20.3%, p = 0.033) in the older patients. The multivariable analysis of the TTR did not indicate a statistically significant effect of age (hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 0.98–1.44; p = 0.082). The HR comparing older with younger patients was 1.34 (95% CI: 1.12–1.59; p = 0.001) for DFS, 1.58 (95% CI: 1.26–1.99; p < 0.001) for OS, and 1.28 (95% CI: 0.96–1.70; p = 0.089) for CSS. Conclusions: Worse prognostic factors and reduced treatment compliance have a negative impact on the efficacy of oxaliplatin-based adjuvant therapy in older patients.
Mar 18
148
190
201
Adjuvant chemotherapy; Colon cancer; Compliance; Older patients; Oxaliplatin; Prognostic factors
Rosati G.; Lonardi S.; Galli F.; Di Bartolomeo M.; Ronzoni M.; Zampino M.G.; Banzi M.; Zaniboni A.; Pasini F.; Bozzarelli S.; Garattini S.K.; Ferrari D.; Montesarchio V.; Mambrini A.; Ciuffreda L.; Galli F.; Pusceddu V.; Carlomagno C.; Bidoli P.; Amoroso D.; Bochicchio A.M.; Frassineti L.; Corsi D.; Bilancia D.; Pastorino A.; De Stefano A.; Labianca R.; Bilancia D.; Rosati G.; Montesarchio V.; Iaffaioli R.V.; Nasti G.; Daniele B.; Zagonel V.; Lonardi S.; Pella N.; Aprile G.; Pasini F.; Marchetti R.P.; Romiti A.; Ciuffreda L.; Ferrari D.; Foa P.; Zaniboni A.; Labianca R.; Mosconi S.; Sobrero A.; Bidoli P.; Cazzaniga M.; Beretta G.D.; Corsi D.C.; Cortesi E.; Barni S.; Petrelli F.; Allione P.; D'Arco A.M.; Valmadre G.; Piazza E.; Veltri E.; Ramus G.V.; Giustini L.; Tumulo S.; Cascinu S.; Granetto C.; Testore F.; Giordano M.; Moroni M.; Di Seri M.; Nuzzo A.; Angelelli L.; Gori S.; Farina G.; Aglietta M.; Franchi R.; Comande M.; Giordani P.; Tonini G.; Bucci E.; Ballestrero A.; Benasso M.; Graiff C.; Bravi S.; Caffo O.; Silva R.R.; Frontini L.; Rota S.; Cozzi L.; Cantore M.; Maiello E.; Cinieri S.; Silvestris N.; Romito S.; Gebbia V.; Banzi M.; Santoro A.; Artioli F.; Mattioli R.; Contu A.; Di Costanzo F.; Leonardi F.; Cavanna L.; Passalacqua R.; Amoroso D.; Sozzi P.; D'Amico M.; Amadori D.; Frassineti L.; Turci D.; Ravaioli A.; Pasquini E.; Gambi A.; Faedi M.; Cruciani G.; Bajetta E.; Di Bartolomeo M.; Gianni L.; Ronzoni M.; Ionta M.T.; Massidda B.; Scartozzi M.; Zampino M.G.; Bochicchio A.M.; Ciarlo A.; Di Leo A.; Frustaci S.; Rangoni G.; Arizzoia A.; Pavesi L.; Verusio C.; Pinotti G.; Iop A.; De Placido S.; Carlomagno C.; Adamo V.; Ficorella C.; Natale D.; Greco E.; Rulli E.; Galli F.; Poli D.; Porcu L.; Torri V.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2318/1787494
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