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Adjuvant Oxaliplatin in Older Adults With Adjuvant Colorectal Cancer

Oxaliplatin provides no benefit when added to the treatment of older adults aged 70 years or more with resected high-risk colorectal cancer (CRC), authors of a pooled analysis conclude. Clinical trials with geriatric populations with colorectal cancer “are urgently required,” the authors conclude.

A systematic review identified 5 articles with overall survival (OS) data for 1,985 patients. “Oxaliplatin-based [chemotherapy (CT)] significantly reduced the mortality risk by 26% in younger patients (random-effect; HR, 0.74; 95% CI, 0.64 to 0.84; P < .01) but not in older patients with CRC (HR, 1.02; 95% CI, 0.82 to 1.27; P = .88). Moderate heterogeneity was observed in OS analysis (P = .001; I2 = 67%). The test for subgroup differences was significant. Similar results were observed for the [disease-free survival].”

The authors describe the relevance of their pooled analysis: “According to the results of our study, it can be concluded that the addition of oxaliplatin to adjuvant therapy for resected high-risk CRC in older patients does not result in any statistically significant gain in terms of preventing recurrences or saving lives. This information was obtained from all major adjuvant trials in high-risk CRC. The results expand the current knowledge by adding further trials to the main pooled analysis already published in the literature for more than 1,000 elderly patients with CRC. It is well known that oxaliplatin may increase hematological toxicity in elderly patients with CRC, although older age per se was not associated with increased rates of severe toxicities in a pooled analysis of oxaliplatin trials for early and advanced disease. However, these data were derived from selected patients enrolled in clinical studies. Grade 3-4 toxicities may have a crucial effect on the dose intensity received and completion of planned cycles, which explains the reduced benefit observed in the elderly patients.”

Source: Journal of Clinical Oncology