title: Patterns of Treatment Sequences in Chemotherapy and Targeted Biologics for Metastatic Colorectal Cancer: Findings from a Large Community-Based Cohort of Elderly Patients.
abstract: BACKGROUND
  Over the last decade, multiple chemotherapies/targeted biologics have been approved for metastatic colorectal cancer (mCRC). However, evidence is limited with regards to the array of treatments received by mCRC patients.
  
  
  OBJECTIVE
  This study examines treatment sequences (first- to third-line chemotherapy/targeted biologics) and the factors associated with first-line targeted biologics and common treatment sequences for elderly mCRC patients treated in a community setting.
  
  
  METHODS
  A retrospective cohort study was conducted in mCRC patients diagnosed from January 2004 through December 2009 using the Surveillance, Epidemiology and End Results Medicare-linked database. The treatment sequences administered to elderly mCRC patients were empirically identified.
  
  
  RESULTS
  Of 4418 mCRC patients who received treatment, 1370 (31 %) received first, second, and third line; 1164 (26 %) received first and second line; and 1884 (43 %) received only first line. The most common first line of treatment for mCRC patients was 5-fluorouracil/leucovorin + oxaliplatin (FOLFOX) + bevacizumab (23 %) and FOLFOX (23 %). 5-fluorouracil/leucovorin + irinotecan (FOLFIRI)-based regimens were commonly (22 %) administered in second line. The most common treatment sequence was first-line oxaliplatin or irinotecan followed by second-line oxaliplatin or irinotecan + bevacizumab followed by a third-line targeted biologic. Of patients who received first-line therapy, 47 % also received a targeted biologic, and the factors associated were age, comorbidity score, cancer site, geographic location, and year of diagnosis.
  
  
  CONCLUSIONS
  Elderly mCRC patients receive a multitude of treatments in various sequences. Further exploration of the comparative effectiveness of treatment sequences may yield important information for improving mCRC survival.
authors.affiliation: Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Dr, RAS-E929, Houston, TX, 77030, USA. rohanparikh23@gmail.com.
authors.forename: Rohan C
authors.initials: RC
authors.lastname: Parikh
authors.affiliation: Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Dr, RAS-E929, Houston, TX, 77030, USA.|Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Xianglin L
authors.initials: XL
authors.lastname: Du
authors.affiliation: Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Dr, RAS-E929, Houston, TX, 77030, USA.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Morgan
authors.affiliation: Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Dr, RAS-E929, Houston, TX, 77030, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Lairson