Oxaliplatin plus fluoropyrimidines as adjuvant therapy for colon cancer in older patients: A subgroup analysis from the TOSCA trial. (May 2021)

• Record Type: Journal Article
• Authors: Rosati, Gerardo; Lonardi, Sara; Galli, Fabio; Di Bartolomeo, Maria; Ronzoni, Monica; Zampino, Maria G.; Banzi, Maria; Zaniboni, Alberto; Pasini, Felice; Bozzarelli, Silvia; Garattini, Silvio K.; Ferrari, Daris; Montesarchio, Vincenzo; Mambrini, Andrea; Ciuffreda, Libero; Galli, Francesca; Pusceddu, Valeria; Carlomagno, Chiara; Bidoli, Paolo; Amoroso, Domenico; Bochicchio, Anna M.; Frassineti, Luca; Corsi, Domenico; Bilancia, Domenico; Pastorino, Alessandro; De Stefano, Alfonso; Labianca, Roberto; Bilancia, D.; Rosati, G.; Montesarchio, V.; Iaffaioli, R.V.; Nasti, G.; Daniele, B.; Zagonel, V.; Lonardi, S.; Pella, N.; Aprile, G.; Pasini, F.; Marchetti, Roma 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. Vietti; 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.; Comandé, 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.; Bajetta, E.; De Placido, S.; Carlomagno, C.; Adamo, V.; Ficorella, C.; Natale, D.; Greco, E.; Rulli, E.; Galli, F.; Poli, D.; Porcu, L.; Torri, V.;
• Is Part Of: European journal of cancer. Volume 148(2021)
• Page Start: 190
• Page End: 201
• Publication Date: 2021-05
• Subjects: Adjuvant chemotherapy -- Colon cancer -- Compliance -- Older patients -- Oxaliplatin -- Prognostic factors; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2021.01.051
• Languages: English
• ISSNs: 0959-8049

Abstract

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. Highlights: The outcome of oxaliplatin as an adjuvant therapy in elderly patients with colon cancer is doubt. Worse prognostic factors and reduced compliance have a negative impact on its effectiveness. Fluoropyrimidine monotherapy is an appropriate choice for most elderly patients. Only fit elderly patients should receive oxaliplatin as an adjuvant therapy.