This transcript has been edited for clarity.
Hello. I’m David Kerr, Professor of Cancer Medicine at the University of Oxford. One of his enduring interests of mine, part of my daily routine as a medical oncologist, is considering whether to recommend adjuvant therapy to a patient who has just undergone a potentially curative resection. That’s it. colorectal cancer.
Our group, the QUASAR group, has made very significant contributions in terms of experimentation and knowledge in this field. One thing that we still need to discuss and think about in the broader community is the impact of adjuvant chemotherapy in elderly patients.
Colorectal cancer is a disease of the elderly, with a median age of onset of approximately 72 years. It is known that more than 50% of patients at the time of onset are over 65 years old, and one third of patients are over 75 years old. It is a disease that mainly affects the elderly. Is combination chemotherapy justified? Oxaliplatin For high-risk resected colorectal cancer patients?
There was a very nice report A meta-analysis by Dottorini et al. What came out recently Journal of Clinical Oncology. It’s a great group. They conducted their meta-analysis work following a rigorous and rational protocol. Their statistical analysis was spot on and they collected data from all relevant trials.
Their study results showed that adding oxaliplatin to adjuvant therapy for resected high-risk colorectal cancer in elderly patients (patients 70 years and older) had no statistically significant effect in preventing recurrence. We can conclude that it is not possible. Or to save lives.
when we did QUASAR exam, initially considered control and fluoropyrimidine chemotherapy. Although there was an overall effect on survival for the entire study group (5000 patients in our study), by decile, fluoropyrimidine therapy had a significant Even so, profits had declined significantly. We believe that this careful meta-analysis should raise questions about the use of oxaliplatin in elderly patients.
How can you explain it? Why is the well-known and described benefit of oxaliplatin, especially for stage III disease, diminished in older adults? It may be related to reduced dose intensity. Side effects are more common in the elderly. Therefore, chemotherapy will not be completed as planned. However, these days he tends to only do three-month treatments.
Is there something biological about biology and the status of somatic mutations in tumors in older people? i don’t think so. Indeed, we know that in terms of stem cell reserves that are resistant to the side effects of chemotherapy, as in younger people, that declines with age.
Food for thought: Most of the patients I see in my clinic for adjuvant therapy are elderly. These days, the majority of patients present with high-risk stage II or stage III disease. There is a real question mark as to whether oxaliplatin should be used in the first place.
Clearly, further trials of chemotherapy in older adults are needed to see if adding drugs like oxaliplatin to the fluoropyrimidine backbone really makes a difference. As I have said many times, those of us in the medical community who recommend adjuvant therapy need to do better risk stratification. Better prognostic markers are needed. Better indicators are needed to enable consideration of these combination therapies in more focused groups of patients who may be at high risk of recurrence.
Look at the paper and think about what you think. I think it’s well done. It certainly made me pause and think about the treatments we provide to older patients.
please think about it. Please let us know if you have any feedback. For the time being, Medscapers is over. Thank you for listening.
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