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22.02.2021 | Original Research Article Open Access

First-Line Biological Agents Plus Chemotherapy in Older Patients with Metastatic Colorectal Cancer: A Retrospective Pooled Analysis

Drugs & Aging
Pilar García-Alfonso, Eduardo Díaz-Rubio, Albert Abad, Alfredo Carrato, Bartomeu Massutí, María José Ortiz-Morales, José Luis Manzano Mozo, Andrés Muñoz, Gema Durán, Javier Sastre, María José Safont, Reyes Ferreiro, Fernando Rivera, Encarnación González, Manuel Valladares-Ayerbes, Cristina Grávalos, Vicente Alonso-Orduña, José María Viéitez, Alfonso Yubero, Enrique Aranda, the Spanish Cooperative Group for the Treatment of Digestive Tumors (TTD)
Wichtige Hinweise

Supplementary Information

The online version contains supplementary material available at https://​doi.​org/​10.​1007/​s40266-021-00834-w.
The collaborator names of the Spanish Cooperative Group for the Treatment of Digestive Tumors (TTD) are present in the Acknowledgements section.



Biologicals, in combination with chemotherapy, are recommended as first-line treatment of metastatic colorectal cancer (mCRC); however, evidence guiding the appropriate management of older patients with mCRC is limited.


This study was undertaken to compare the efficacy and safety outcomes in older versus younger patients with mCRC who received first-line biological therapy.


This retrospective analysis used pooled data from five trials undertaken by the Spanish Cooperative Group for the Treatment of Digestive Tumours. All were studies of adults with advanced CRC who received first-line treatment with chemotherapy plus bevacizumab, cetuximab or panitumumab, stratified by age (≥ 65 vs. < 65 years). Endpoints included progression-free survival (PFS), overall survival (OS), overall response rate (ORR) and safety.


In total, 999 patients from five studies were included in the analysis: 480 (48%) were aged ≥ 65 years, and 519 (52%) were aged < 65 years. Median PFS did not differ significantly between patients aged ≥ 65 and < 65 years (9.9 vs. 9.4 months; hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.88–1.17). Median OS was significantly shorter in older than in younger patients (21.3 vs. 25.0 months; HR 1.21; 95% CI 1.04–1.41). There was no significant difference between older and younger patients in ORR (59 vs. 62%). Patients aged ≥ 65 years experienced significantly more treatment-related grade 3 or higher adverse events (61.67%) than did patients aged < 65 years (45.86%).


Biologicals plus chemotherapy is an effective first-line treatment option for selected patients aged ≥ 65 years with mCRC and has a manageable safety profile and efficacy comparable to that observed in younger patients.

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