title: Chronological Age and Risk of Chemotherapy Nonfeasibility: A Real-Life Cohort Study of 153 Stage II or III Colorectal Cancer Patients Given Adjuvant-modified FOLFOX6.
abstract: OBJECTIVE
  To assess nonfeasibility of adjuvant-modified FOLFOX6 chemotherapy in patients with stage II or III colorectal cancer.
  
  
  METHODS
  Consecutive patients managed between 2009 and 2013 in 2 teaching hospitals in the Paris urban area were included in the CORSAGE (COlorectal canceR, AGe, and chemotherapy fEasability study) cohort study. Nonfeasibility was defined by the frequencies of empirical first-cycle dose reduction (>15%), early discontinuation (<12 cycles), and low relative dose intensity (RDI) (<0.85). Risk factors for chemotherapy nonfeasibility were identified using multivariate logistic regression.
  
  
  RESULTS
  Among 153 patients, 56.2% were male (median age, 65.6 y; 35.3%≥70 y; 7.3% with performance status [PS]≥2). For 5-fluorouracil (5-FU), 20.9% of patients had first-cycle dose reduction and 28.1% early discontinuation; RDI was 0.91 (25th to 75th percentiles, 0.68 to 0.99). Factors independently associated with first-cycle 5-FU dose reduction were aged 65 to 69 years versus those younger than 65 years (adjusted odds ratio [aOR], 5.5; 95% confidence interval [CI], 1.5-19.9) but not age 70 years and older, PS≥2 (aOR, 6.02; 95% CI, 1.15-31.4), higher Charlson Comorbidity Index (aOR1-point increase, 1.4; 95% CI, 1.05-1.82), or larger number of medications (aOR 1-medication increase, 1.19; 95% CI, 1.00-1.42). Oxaliplatin dose reduction occurred in 52.3% of patients and early discontinuation in 62.7%; the latter was more common in the 70 years and older group (92.6% vs. 74.6% in the <65-y group; P=0.01); RDI was 0.7 (95% CI, 0.55-0.88).
  
  
  CONCLUSIONS
  In the real-world setting, compared with their younger and older counterparts, patients aged 65 to 69 years given modified FOLFOX6 for stage II or III colorectal cancer had higher frequencies of 5-FU nonfeasibility defined based on first-cycle dose reduction, early discontinuation, and RDI; and these differences were independent from PS, comorbidities, and number of medications.
authors.affiliation: IMRB-EA 7376 CEpiA Clinical Epidemiology And Ageing, Faculty of Medicine, A-TVB DHU.|Geriatric Oncology Unit, Geriatrics Department.
authors.forename: Marie
authors.initials: M
authors.lastname: Laurent
authors.affiliation: Gastro Enterology and Digestive Oncology, APHP, Avicennes Hospital.
authors.forename: Gaétan
authors.initials: G
authors.lastname: Des Guetz
authors.affiliation: IMRB-EA 7376 CEpiA Clinical Epidemiology And Ageing, Faculty of Medicine, A-TVB DHU.|Public Healh Department, APHP, Henri Mondor Hospital.|Research Clinic Unit.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bastuji-Garin
authors.affiliation: Medical Oncology Department, APHP, Saint-Louis Hospital.|Faculty of Medicine, Paris Diderot University.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Culine
authors.affiliation: IMRB-EA 7376 CEpiA Clinical Epidemiology And Ageing, Faculty of Medicine, A-TVB DHU.|Geriatric Oncology Unit, Geriatrics Department.
authors.forename: Philippe
authors.initials: P
authors.lastname: Caillet
authors.affiliation: Gastro Enterology and Digestive Oncology, APHP, Avicennes Hospital.|Sorbonne Paris Cite-Paris 13 University, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Aparicio
authors.affiliation: IMRB-EA 7376 CEpiA Clinical Epidemiology And Ageing, Faculty of Medicine, A-TVB DHU.|Public Healh Department, APHP, Henri Mondor Hospital.
authors.forename: Etienne
authors.initials: E
authors.lastname: Audureau
authors.affiliation: Pharmacy Department.
authors.forename: Muriel
authors.initials: M
authors.lastname: Carvahlo-Verlinde
authors.affiliation: IMRB-EA 7376 CEpiA Clinical Epidemiology And Ageing, Faculty of Medicine, A-TVB DHU.|Geriatric Oncology Unit, Geriatrics Department.
authors.forename: Nicoleta
authors.initials: N
authors.lastname: Reinald
authors.affiliation: Medical Oncology Department, APHP, Henri Mondor Hospital, Creteil.|Faculty of Medicine, Paris-Est University.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tournigand
authors.affiliation: Geriatric Oncology Unit, Pharmacy Department, APHP, Rene Muret Hospital, Bobigny.
authors.forename: Thierry
authors.initials: T
authors.lastname: Landre
authors.affiliation: IMRB-EA 7376 CEpiA Clinical Epidemiology And Ageing, Faculty of Medicine, A-TVB DHU.|Public Healh Department, APHP, Henri Mondor Hospital.|Research Clinic Unit.
authors.forename: Aurélie
authors.initials: A
authors.lastname: LeThuaut
authors.affiliation: IMRB-EA 7376 CEpiA Clinical Epidemiology And Ageing, Faculty of Medicine, A-TVB DHU.|Geriatric Oncology Unit, Geriatrics Department.
authors.forename: Elena
authors.initials: E
authors.lastname: Paillaud
authors.affiliation: IMRB-EA 7376 CEpiA Clinical Epidemiology And Ageing, Faculty of Medicine, A-TVB DHU.|Public Healh Department, APHP, Henri Mondor Hospital.
authors.forename: Florence
authors.initials: F
authors.lastname: Canouï-Poitrine
mesh_terms: D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D005602:France; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil