Oncologie

, Volume 10, Issue 3, pp 182–186

La chimiothérapie dans les cancers colorectaux chez les sujets âgés

Original

Résumé

Le cancer colorectal survient après 75 ans dans près de la moitiédes cas. Les patients âgés restent globalement soustraités et sont loin de bénéficier d’une prise en charge optimale. Les données disponibles suggèrent que chez les patients âgés en bon état général et sans comorbidités importantes, l’efficacité des chimiothérapies est proche de ce qui est observé chez les patients plus jeunes avec cependant une possible majoration de la toxicité, en particulier hématologique.

Mots clés

Cancer colorectal Chimiothérapie Sujets âgés 

Chemotherapy for colorectal cancer in elderly patients

Abstract

Colorectal cancer occurs after the age of 75 in 50% of cases, but elderly patients are generally under-treated and receive far from optimal management of their disease. Available data suggests, however, that among elderly patients in general good health and with no severe comorbidities, the efficacy of chemotherapy is similar to that observed in younger patients, though with a trend towards increased hematological toxicity.

Keywords

Colorectal cancer Chemotherapy Elderly patients 

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Références

  1. 1.
    Aparicio T, Desrame J, Lecomte T, et al. (2003) Oxaliplatin-or irinotecan-based chemotherapy for metastatic colorectal cancer in the elderly. Br J Cancer 89: 1439–1444PubMedCrossRefGoogle Scholar
  2. 2.
    Beretta G, Bollina R, Cozzi C, et al. (1997) Should we consider the weekly (w) chemotherapy (CT) with fluorouracil (F) + racemic folinic acid (f) a standard treatment for advanced-metastatic carcinoma of digestive tract (DTC) in elderly patients (pts)? Proc Am Soc Clin Oncol 16: 259aGoogle Scholar
  3. 3.
    Berretta M, Bearz A, Frustaci S, et al. (2006) FOLFOX2 regimen in the treatment of advanced colorectal cancer: a comparison between elderly and young patients. Ann Oncol 17: 1606–1607PubMedCrossRefGoogle Scholar
  4. 4.
    Cassidy J, Twelves C, Van Cutsem E, et al. (2002) First-line oral capecitabine therapy in metastatic colorectal cancer: a favorable safety profile compared with intravenous 5-fluorouracil-leucovorin. Ann Oncol 13: 566–575PubMedCrossRefGoogle Scholar
  5. 5.
    Chiara S, Nobile MT, Vincenti M, et al. (1998) Advanced colorectal cancer in the elderly: results of consecutive trials with 5-fluorouracil-based chemotherapy. Cancer Chemother Pharmacol 42: 336–340PubMedCrossRefGoogle Scholar
  6. 6.
    Comella P, Natale D, Farris A, et al. (2005) Capecitabine plus oxaliplatin for the first-line treatment of elderly patients with metastatic colorectal carcinoma. Cancer 104: 282–289PubMedCrossRefGoogle Scholar
  7. 7.
    Daniele B, Rosati G, Tambaro R, et al. (2003) First-line chemotherapy with fluorouracil and folinic acid for advanced colorectal cancer in elderly patients: a phase II study. J Clin Gastroenterol 36: 228–233PubMedCrossRefGoogle Scholar
  8. 8.
    Dobie SA, Baldwin LM, Dominitz JA, et al. (2006) Completion of therapy by Medicare patients with stage III colon cancer. J Natl Cancer Inst 98: 610–619PubMedCrossRefGoogle Scholar
  9. 9.
    Faivre-Finn C, Bouvier AM, Mitry E, et al. (2002) Chemotherapy for colon cancer in a well-defined French population: is it under-or over-prescribed? Aliment Pharmacol Ther 16: 353–359PubMedCrossRefGoogle Scholar
  10. 10.
    Feliu J, Escudero P, Llosa F, et al. (2005) Capecitabine as first-line treatment for patients older than 70 years with metastatic colorectal cancer: an oncopaz cooperative group study. J Clin Oncol 23: 3104–3111PubMedCrossRefGoogle Scholar
  11. 11.
    Feliu J, Salud A, Escudero P, et al. (2006) XELOX (capecitabine plus oxaliplatin) as first-line treatment for elderly patients over 70 years of age with advanced colorectal cancer. Br J Cancer 94: 969–975PubMedCrossRefGoogle Scholar
  12. 12.
    Figer A, Perez-Staub N, Carola E, et al. (2007) FOLFOX in patients aged between 76 and 80 years with metastatic colorectal cancer: an exploratory cohort of the OPTIMOX1 study. Cancer 110: 2666–2671PubMedCrossRefGoogle Scholar
  13. 13.
    Folprecht G, Cunningham D, Ross P, et al. (2004) Efficacy of 5-fluorouracil-based chemotherapy in elderly patients with metastatic colorectal cancer: a pooled analysis of clinical trials. Ann Oncol 15: 1330–1338PubMedCrossRefGoogle Scholar
  14. 14.
    Folprecht G, Rougier P, Saltz L, et al. (2006) Irinotecan in first line therapy of elderly and non-elderly patients with metastatic colorectal cancer: meta-analysis of four trials investigating 5FU and irinotecan. J Clin Oncol 24(ASCO Annual Meeting Proceedings Part I): 3578Google Scholar
  15. 15.
    Goldberg RM, Tabah-Fisch I, Bleiberg H, et al. (2006) Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil-leucovorin administered bimonthly in elderly patients with colorectal cancer. J Clin Oncol 24: 4085–4091PubMedCrossRefGoogle Scholar
  16. 16.
    Hochster HS, Luo W, Popa EC, et al. (2007) Phase II study of uracil-tegafur with leucovorin in elderly (> or = 75 years old) patients with colorectal cancer: ECOG 1299. J Clin Oncol 25: 5397–5402PubMedCrossRefGoogle Scholar
  17. 17.
    Hurria A (2007) Incorporation of geriatric principles in oncology clinical trials. J Clin Oncol 25: 5350–5351PubMedCrossRefGoogle Scholar
  18. 18.
    Iwashyna TJ, Lamont EB (2002) Effectiveness of Adjuvant Fluorouracil in Clinical Practice: a Population-Based Cohort Study of Elderly Patients With Stage III Colon Cancer. J Clin Oncol 20: 3992–3998PubMedCrossRefGoogle Scholar
  19. 19.
    Mabro M, Gilles-Amar V, Louvet C, et al. (1999) 5-fluorouracile bimensuel en traitement du cancer colorectal métastasé chez le sujet âgé. Étude de 50 patients. Rev Med Interne 20: 863–868PubMedCrossRefGoogle Scholar
  20. 20.
    Magne N, Francois E, Broisin L, et al. (2002) Palliative 5-Fluorouracil-based chemotherapy for advanced colorectal cancer in the elderly: results of a 10-year experience. Am J Clin Oncol 25: 126–130PubMedCrossRefGoogle Scholar
  21. 21.
    Mattioli R, Lippe P, Recchia F, et al. (2001) Advanced colorectal cancer in elderly patients: tolerance and efficacy of leucovorin and fluorouracil bolus plus continuous infusion. Anticancer Research 21: 489–492PubMedGoogle Scholar
  22. 22.
    Mitry E, Phelip JM, Bonnetain F, et al. (2008) Phase III trial of chemotherapy with or without irinotecan in the frontline treatment of metastatic colorectal cancer in elderly patients. FFCD 2001-02 trial. Results of a planned interim analysis, Gastrointestinal Cancers Symposium. Orlando, p. 209 (abstract 281)Google Scholar
  23. 23.
    Neugut AI, Matasar M, Wang X, et al. (2006) Duration of adjuvant chemotherapy for colon cancer and survival among the elderly. J Clin Oncol 24: 2368–2375PubMedCrossRefGoogle Scholar
  24. 24.
    Popescu RA, Norman A, Ross PJ, et al. (1999) Adjuvant or palliative chemotherapy for colorectal cancer in patients 70 years or older. J Clin Oncol 17: 2412–2418PubMedGoogle Scholar
  25. 25.
    Quasar Collaborative G, Gray R, Barnwell J, et al. (2007) Adjuvant chemotherapy vs observation in patients with colorectal cancer: a randomised study. Lancet 370: 2020–2029CrossRefGoogle Scholar
  26. 26.
    Rougier P, Mitry E, Cunningham D, et al. (2003) Is age a prognostic factor of toxicity and efficacy in patients (pts) with metastatic colorectal cancer (MCRC) receiving irinotecan in combination with 5FU-folinic acid (FA). Proc Am Soc Clin Oncol 22: 267Google Scholar
  27. 27.
    Sargent DJ, Goldberg RM, Jacobson SD, et al. (2001) A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med 345: 1091–1097PubMedCrossRefGoogle Scholar
  28. 28.
    Sastre J, Marcuello E, Masutti B, et al. (2005) Irinotecan in combination with fluorouracil in a 48-hour continuous infusion as first-line chemotherapy for elderly patients with metastatic colorectal cancer: a Spanish Cooperative Group for the Treatment of Digestive Tumors study. J Clin Oncol 23: 3545–3551PubMedCrossRefGoogle Scholar
  29. 29.
    Simmonds PC (2000) Palliative chemotherapy for advanced colorectal cancer: systematic review and meta-analysis. Colorectal Cancer Collaborative Group. BMJ 321: 531–535PubMedCrossRefGoogle Scholar
  30. 30.
    Stein BN, Petrelli NJ, Douglass HO, et al. (1995) Age and sex are independent predictors of 5-fluorouracil toxicity. Analysis of a large scale phase III trial. Cancer 75: 11–17PubMedCrossRefGoogle Scholar
  31. 31.
    Sundararajan V, Mitra N, Jacobson JS, et al. (2002) Survival associated with 5-fluorouracil-based adjuvant chemotherapy among elderly patients with node-positive colon cancer. Annals of Internal Medicine 136: 349–357PubMedGoogle Scholar
  32. 32.
    Twelves C, Wong A, Nowacki MP, et al. (2005) Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 352: 2696–2704PubMedCrossRefGoogle Scholar

Copyright information

© Springer Verlag France 2008

Authors and Affiliations

  1. 1.Service d’hépatogastro-entérologie et oncologie digestive, UFR médecine Paris-Île-de-France-Ouestuniversité Versailles-Saint-Quentin, CHU Ambroise-Paré, APHPBoulogneFrance

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