Adjuvant or palliative chemotherapy for colorectal cancer in patients 70 years or older

Purpose: The surgical treatment of colorectal cancer (CRC) in elderly patie nts (age 70 years or older) has improved, but data on adjuvant and palliati ve chemotherapy tolerability and benefits in this growing population remain scarce. Elderly patients are underrepresented in clinical trials, and resu lts for older patients are seldom reported separately. Patients and Methods: Using a prospective database, we analyzed demographic s, chemotherapy toxicity, response rates, failure-free survival (FFS), and overall survival (OS) of CRC patients receiving chemotherapy at the Royal M arsden Hospital. The cutoff age was 70 years. Results: A total of 844 patients received first-line chemotherapy with vari ous fluorouracil (5-FU)-containing regimens or raltitrexed for advanced dis ease, and 543 patients were administered adjuvant, protracted venous infusi on 5-FU or bolus 5-FU/folinic acid (FA) chemotherapy. Of the 1,387 patients , 310 were 70 years or older. There was no difference in overall or severe (Common Toxicity Criteria III to IV) toxicity between the two age groups, w ith the exception of more frequent severe mucositis in older patients recei ving adjuvant bolus 5-FU/FA. For patients receiving palliative chemotherapy , no difference in response rates (24% v 29%, P = .19) and median FFS (164 v 168 days) were detected when the elderly were compared with younger patie nts, Median OS was 292 days for the elderly group and 350 days far the youn ger patients (P = .04), and 1-year survival was 44% and 48%, respectively. The length of inpatient hospital stay was identical. Conclusion: Elderly patients with good performance status tolerated adjuvan t and palliative chemotherapy far CRC as well as did younger patients and h ad similar benefits from palliative chemotherapy, (C) 1999 by American Soci ety of Clinical Oncology.