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Metastatic Colorectal Cancer Outcomes by Age Among ARCAD First- and Second-Line Clinical Trials.

Nadine J McCleary1, William S Harmsen2, Ellana Haakenstad1

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Older adults with metastatic colorectal cancer receive less second-line therapy but experience similar survival outcomes to younger adults. Further research is needed to understand treatment disparities and optimize care for elderly patients.

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Area of Science:

  • Oncology
  • Geriatric Medicine
  • Clinical Trials

Background:

  • Metastatic colorectal cancer (mCRC) treatment decisions in older adults require careful consideration.
  • Evaluating second-line therapy in patients aged 70 years and older is crucial for understanding age-related disparities.

Purpose of the Study:

  • To compare time to progression (TTP) and survival outcomes of second-line therapy for mCRC in adults aged 70+ versus younger adults.
  • To identify factors influencing the receipt of second-line therapy in older mCRC patients.

Main Methods:

  • Retrospective analysis of patients from first- and second-line clinical trials for mCRC.
  • Cox regression models were used to compare TTP and overall survival (OS), adjusting for clinical and demographic factors.
  • Analysis included multivariable logistic regression to assess the likelihood of receiving second-line therapy.

Main Results:

  • Older adults (≥70 years) were less likely to receive second-line therapy, with odds decreasing by 11% per decade of age.
  • No statistically significant difference in median TTP (5.1 vs 5.2 months) or median OS (11.6 vs 12.4 months) was observed between older and younger adults in second-line trials.
  • Performance status and specific metastatic sites influenced treatment decisions.

Conclusions:

  • Older adults with mCRC are underrepresented in second-line therapy, despite comparable survival outcomes post-treatment.
  • Further investigation into factors influencing second-line treatment decisions for elderly patients is warranted.
  • Geriatric assessments may improve risk-benefit evaluations for older adults considering second-line mCRC therapy.