viernes, 15 de junio de 2012

Effect of Adjuvant Chemotherapy on Survival of ... [J Clin Oncol. 2012] - PubMed - NCBI

Chemotherapy May Improve Survival Chances for Elderly Colon Cancer Patients

Patients 75 years or older who have undergone surgery to treat stage III colon cancer may live longer if treated with supplemental chemotherapy, according to new research from AHRQ’s Effective Health Care Program. While 40 percent of all people diagnosed with colon cancer are 75 years or older, and they account for half of all colorectal cancer deaths, elderly patients and their physicians lack clear standards to guide treatment decisions. As a result, the use of any chemotherapy option drops off quickly with advancing age. Findings suggest that clinicians should consider using supplemental chemotherapy for colon cancer patients older than 75 while assessing individual risks and preferences. Select to access the abstract of the June 4 online issue of the Journal of Clinical Oncology article, Effect of Adjuvant Chemotherapy on Survival of Patients with Stage III Colon Cancer Diagnosed After 75 Years on PubMed.®

J Clin Oncol. 2012 Jun 4. [Epub ahead of print]

Effect of Adjuvant Chemotherapy on Survival of Patients With Stage III Colon Cancer Diagnosed After Age 75 Years.

Sanoff HK, Carpenter WR, Stürmer T, Goldberg RM, Martin CF, Fine JP, McCleary NJ, Meyerhardt JA, Niland J, Kahn KL, Schymura MJ, Schrag D.

Source

Hanna K. Sanoff, University of Virginia, Charlottesville, VA; William R. Carpenter, Til Stürmer, Richard M. Goldberg, Christopher F. Martin, and Jason P. Fine, University of North Carolina, Chapel Hill,NC; Nadine Jackson McCleary, Jeffrey A. Meyerhardt, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Joyce Niland, City of Hope Cancer Center and Data Coordinating Center for the National Comprehensive Cancer Center, Duarte; Katherine L. Kahn, RAND Corporation, Santa Monica; Katherine L. Kahn, David Geffen School of Medicine at University of California, Los Angeles, CA; and Maria J. Schymura, New York State Cancer Registry, New York State Department of Health, Albany, NY.

Abstract

PURPOSEFew patients 75 years of age and older participate in clinical trials, thus whether adjuvant chemotherapy for stage III colon cancer (CC) benefits this group is unknown. METHODSA total of 5,489 patients ≥ 75 years of age with resected stage III CC, diagnosed between 2004 and 2007, were selected from four data sets containing demographic, stage, treatment, and survival information. These data sets included SEER-Medicare, a linkage between the New York State Cancer Registry (NYSCR) and its Medicare programs, and prospective cohort studies Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) and the National Comprehensive Cancer Network. Data sets were analyzed in parallel using covariate adjusted and propensity score (PS) matched proportional hazards models to evaluate the effect of treatment on survival. PS trimming was used to mitigate the effects of selection bias.ResultsUse of adjuvant therapy declined with age and comorbidity. Chemotherapy receipt was associated with a survival benefit of comparable magnitude to clinical trials results (SEER-Medicare PS-matched mortality, hazard ratio [HR], 0.60; 95% CI, 0.53 to 0.68). The incremental benefit of oxaliplatin over non-oxaliplatin-containing regimens was also of similar magnitude to clinical trial results (SEER-Medicare, HR, 0.84; 95% CI, 0.69 to 1.04; NYSCR-Medicare, HR, 0.82, 95% CI, 0.51 to 1.33) in two of three examined data sources. However, statistical significance was inconsistent. The beneficial effect of chemotherapy and oxaliplatin did not seem solely attributable to confounding. CONCLUSIONThe noninvestigational experience suggests patients with stage III CC ≥ 75 years of age may anticipate a survival benefit from adjuvant chemotherapy. Oxaliplatin offers no more than a small incremental benefit. Use of adjuvant chemotherapy after the age of 75 years merits consideration in discussions that weigh individual risks and preferences.