To compare benefits and risks to adjuvant chemotherapy following complete resection of nodepositive colon cancer stage III for patients aged ≥75 yr and younger.
A retrospective study compared recurrence-free and overall survival, toxicity, and dose intensity of adjuvant bolus 5-FU according to the Mayo regimen chemotherapy in consecutive patients aged 19–74 (n=203) and ≥75 yr (n=24).
The estimated 5-yr proportional survival rates were 0.65 for patients age less than 75 yr compared to 0.65 (p=0.96) for elderly. The frequencies of anemia (0%), thrombocytopenia (0%), leukopenia (4%), infection *8%), vomiting (0%), mucositis (17%), diarrhea (13%) CTC grade 3 or 4 toxicity in elderly patients were not significantly different from that in younger patients (p>0.05). Significantly more elderly (8%) had a decline in performance status to grade 3 or 4, as compared to younger patients (4%) (p=0.002). 5-FU dose reduction was necessary for significantly more elderly (51%) as compared to younger patients (28%) (p=0.02), and fewer elderly (54%) completed the scheduled six treatment courses as compared to younger patients (82%) (p=0.05).
Adjuvant 5-FU chemotherapy should be considered for elderly patients aged ≥75 yr in good performance at high risk of recurrence of colon carcinoma after resection.
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Midgley R, Kerr D. Colorectal cancer. Lancet 1999; 353: 391–399.
Cooper GS, Yuan Z, Landefeld CS, Johanson JF, Rimm AA. A national population-based study of incidence of colorectal cancer and age. Implications for screening in older Americans. Cancer 1995; 75: 775–781.
Moertel CG, et al. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 1990; 322: 352–358.
Laurie JA, et al. Surgical adjuvant therapy of large-bowel carcinoma: an evaluation of levamisole and the combination of levamisole and fluorouracil. The North Central Cancer Treatment Group and the Mayo Clinic. J Clin Oncol 1989; 7: 1447–1456.
Mamounas E, et al. Comparative efficacy of adjuvant chemotherapy in patients with Dukes' B versus Dukes' C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project adjuvant studies (C-01, C-02, C-03, and C-04). J Clin Oncol 1999; 17: 1349–1355.
O'Connell MJ, et al. Prospectively randomized trial of post-operative adjuvant chemotherapy in patients with high-risk colon cancer. J Clin Oncol 1998; 16: 295–300.
Francini G, et al. Folimic acid and 5-fluorouracil as adjuvant chemotherapy in colon cancer. Gastroenterology 1994; 106: 899–906.
Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators Lancet 1995; 345: 939–944.
Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) Investigators. J Clin Oncol 1999; 17: 1356–1363.
Sargent DJ, et al. A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med 2001; 345: 1091–1097.
NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990; 264: 1444–1450.
Schrag D, Cramer LD, Bach PB, Begg CB. Age and adjuvant chemotherapy use after surgery for stage III colon cancer. J Natl Cancer Inst 2001; 93: 850–857.
Lemmens VE, et al. Adjuvant treatment for elderly patients with stage III colon cancer in the southern Netherlands is affected by socioeconomic status, gender, and comorbidity. Ann Oncol 2005; 16: 767–772.
Sundararajan V, Grann VR, Jacobson JS, Ahsan H, Neugut AI. Variations in the use of adjuvant chemotherapy for nodepositive colon cancer in the elderly: a population-based study. Cancer J 2001; 7: 213–218.
Jessup JM, McGinnis LS, Steele GD, Jr., Menck HR, Winchester DP. The National Cancer Data Base. Report on colon cancer. Cancer 1996; 78: 918–926.
Hutchins, LF, Unger JM, Crowley JJ, Coltman CA, Jr., Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 1999; 341: 2061–2067.
Wolmark N, et al. Clinical trial to assess the relative efficacy of fluorouracil and leucovorin, fluorouracil and levamisole, and fluorouracil, leucovorin, and levamisole in patients with Dukes' B and C carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project C-04. J Clin Oncol 1999; 17: 3553–3559.
Wolmark N, et al. The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. J Clin Oncol 1993; 11: 1879–1887.
Andre T, et al. Semimonthly versus monthly regimen of fluorouracil and leucovorin administered for 24 or 36 weeks as adjuvant therapy in stage II and III colon cancer: results of a randomized trial. J Clin Oncol 2003; 21: 2896–2903.
Fata F, et al. Efficacy and toxicity of adjuvant chemotherapy in elderly patients with colon carcinoma: a 10-year experience of the Geisinger Medical Center. Cancer 2002; 94: 1931–1938.
Elsaleh H, et al. Association of tumour site and sex with survival benefit from adjuvant chemotherapy in colorectal cancer. Lancet 2000; 355: 1745–1750.
Aschele C, et al. Adjuvant treatment of colorectal cancer in the elderly. Cancer Control 1995; 2: 36–38.
Popescu RA, Norman A, Ross PJ, Parikh B, Cunningham D. Adjuvant or palliative chemotherapy for colorectal cancer in patients 70 years or older. J Clin Oncol 1999; 17: 2412–2418.
Patel K, et al. Weekly 5-fluorouracil and leucovorin: achieving lower toxicity with higher dose-intensity in adjuvant chemotherapy after colorectal cancer resection. Ann Oncol 2004; 15: 568–573.
Kerr DJ, Gray R, McConkey C, Barnwell J: Adjuvant chemotherapy with 5-fluorouracil, L-folinic acid and levamisole for patients with colorectal cancer: non-randomised comparison of weekly versus four-weekly schedules—less pain, same gain. QUASAR Colorectal Cancer Study Group. Ann Oncol 2000; 11: 947–955.
Comparison of fluorouracil with additional levamisole, higher-dose folinic acid, or both, as adjuvant chemotherapy for colorectal cancer: a randomised trial. QUASAR Collaborative Group. Lancet 2000; 355: 1588–1596.
Tsalic M, Bar-Sela G, Beny A, Visel B, Haim N. Severe toxicity related to the 5-fluorouracil/leucovorin combination (the Mayo Clinic regimen): a prospective study in colorectal cancer patients. Am J Clin Oncol 2003; 26: 103–106.
Iwashyna TJ, Lamont EB. Effectiveness of adjuvant fluorouracil in clinical practice: a population-based cohort study of elderly patients with stage III colon cancer. J Clin Oncol 2002; 20: 3992–3998.
Sundararajan V, et al. Survival associated with 5-fluorouracil-based adjuvant chemotherapy among elderly patients with node-positive colon cancer. Ann Intern Med 2002; 136: 349–357.
McCusker J, Wax A, Bennett JM. Cancer patient accessions into clinical trials: a pilot investigation into some patient and physician determinants of entry. Am J Clin Oncol 1982; 5: 227–236.
Penman DT, et al. Informed consent for investigational chemotherapy: patients' and physicians' perceptions. J Clin Oncol 1984; 2: 849–855.
McLean AJ, Le Couteur DG. Aging biology and geriatric clinical pharmacology. Pharmacol Rev 2004; 56: 163–184.
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Jensen, S.A., Vilmar, A. & Sørensen, J.B. Adjuvant chemotherapy in elderly patients (≥75 yr) completely resected for colon cancer stage III compared to younger patients. Med Oncol 23, 521–531 (2006). https://doi.org/10.1385/MO:23:4:521
- Colonic neoplasms
- disease-free survival
- adverse effects