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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

Laurent, Marie MD*,†; Des Guetz, Gaétan MD; Bastuji-Garin, Sylvie MD, PhD*,§,∥; Culine, Stéphane MD, PhD¶,#; Caillet, Philippe MD*,†; Aparicio, Thomas MD, PhD‡,**; Audureau, Etienne MD, PhD*,§; Carvahlo-Verlinde, Muriel PharmD††; Reinald, Nicoleta MD*,†; Tournigand, Christophe MD, PhD‡‡,§§; Landre, Thierry PharmD∥∥; LeThuaut, Aurélie MSc*,§,∥; Paillaud, Elena MD, PhD*,†; Canouï-Poitrine, Florence MD, PhD*,§

American Journal of Clinical Oncology: January 2018 - Volume 41 - Issue 1 - p 73–80
doi: 10.1097/COC.0000000000000233
Original Articles: Gastrointestinal

Objectives: 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.

*IMRB-EA 7376 CEpiA Clinical Epidemiology And Ageing, Faculty of Medicine, A-TVB DHU

§§Faculty of Medicine, Paris-Est University

Geriatric Oncology Unit, Geriatrics Department

§Public Healh Department, APHP, Henri Mondor Hospital

Research Clinic Unit

††Pharmacy Department

‡‡Medical Oncology Department, APHP, Henri Mondor Hospital, Creteil

Gastro Enterology and Digestive Oncology, APHP, Avicennes Hospital

∥∥Geriatric Oncology Unit, Pharmacy Department, APHP, Rene Muret Hospital, Bobigny

Medical Oncology Department, APHP, Saint-Louis Hospital

#Faculty of Medicine, Paris Diderot University

**Sorbonne Paris Cite-Paris 13 University, Paris, France

E.P. and F.C.-P. contributed equally.

The authors declare no conflicts of interest.

Reprints: Marie Laurent, MD, Service de Médecine interne et gériatrie, Hôpital Albert Chenevier, 40 rue de Mesly, Créteil 94000, France. E-mail: marie.laurent@aphp.fr.

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