Outcomes in elderly patients with advanced colorectal cancer treated with capecitabine: a population-based analysis.
BACKGROUND
Toxicity concerns impact the delivery of palliative chemotherapy to elderly patients with advanced colorectal cancer (CRC). Capecitabine was approved for funding in the province of British Columbia in the spring of 2002 as an oral chemotherapeutic option for metastatic CRC.


METHODS
We conducted a population-based study to assess temporal trends in the use of systemic agents in elderly patients. Patients aged > or = 70 years with metastatic CRC diagnosed between January 1, 2000, and December 31, 2000, and between June 1, 2002, and May 31, 2003, were identified through the British Columbia Cancer Agency Registry. The time cohorts were before and after the provincial approval of capecitabine. Data were obtained regarding demographics, systemic therapies, and outcomes.


RESULTS
In cohort A, 35 of 89 patients (39%) were treated with chemotherapy. In the treated versus untreated groups of cohort A, 66% and 57% of patients were male, median ages were 73 years and 76 years, and liver metastasis was seen in 69% and 70% of patients, respectively. In cohort B, 36 of 78 patients (46%) were treated with systemic therapy. In the treated versus untreated groups of cohort B, 58% and 40% of patients were male, median ages were 75 years and 78.5 years, and liver metastasis was seen in 78% and 64% of patients. The most common first-line chemotherapy regimens used in cohort A included single-agent 5-FU in 66%, irinotecan-based regimens in 17%, and other regimens in 11%. First-line chemotherapy in cohort B included capecitabine in 47%, oxaliplatin-based regimens in 19%, and irinotecan-based regimens in 17%. The median times to treatment failure resulting from toxicity, disease progression, or death were 37 days in cohort A and 61 days in cohort B. Overall survival between the 2 time cohorts did not differ significantly. Toxicities resulting in dose delay and/or reduction were comparable.


CONCLUSIONS
We conclude that, in patients > or = 70 years of age with advanced CRC, single-agent 5-FU and capecitabine were the favored palliative regimens in British Columbia in 2000 and 2002, respectively. Capecitabine was well tolerated, and both treatments demonstrated similar survival. There was a trend observed toward a greater proportion of patients being offered systemic therapy in the 2002 cohort; however, the difference was not statistically significant.
Ho
Cheryl
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Division of Medical Oncology, British Columbia Cancer Agency, 600 W. 10th Avenue, Vancouver, BC, Canada V5Z 4E6.
Ng
Kathy
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O'Reilly
Susan
S
Gill
Sharlene
S
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D000069287:Capecitabine; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D000077146:Irinotecan; D008297:Male; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D000077146:Irinotecan; D005472:Fluorouracil; D002166:Camptothecin