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 / 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.; Pella, N.; Aprile, G.; Pasini, F.; Marchetti, R. P.; Romiti, A.; Ferrari, D.; Foa, P.; Zaniboni, A.; 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.; 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.. - In: EUROPEAN JOURNAL OF CANCER. - ISSN 0959-8049. - 148:(2021), pp. 190-201. [10.1016/j.ejca.2021.01.051]
Oxaliplatin plus fluoropyrimidines as adjuvant therapy for colon cancer in older patients: A subgroup analysis from the TOSCA trial
Galli F.;Galli F.;Cascinu S.;Santoro A.;D'Amico M.;Pavesi L.;Galli F.;
2021-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
