Skip to main content
main-content

21.04.2018 | Original Article

Impact of the addition of bevacizumab, oxaliplatin, or irinotecan to fluoropyrimidin in the first-line treatment of metastatic colorectal cancer in elderly patients

Zeitschrift:
International Journal of Colorectal Disease
Autoren:
Thierry Landre, Emilie Maillard, Chérifa Taleb, Djamel Ghebriou, Gaetan Des Guetz, Laurent Zelek, Thomas Aparicio

Abstract

Introduction

The clinical benefit of double-front-line therapy (including oxaliplatin or irinotecan or bevacizumab plus 5-fluorouracil (5FU) or capecitabine) compared to monotherapy (5FU or capecitabine) in elderly (> 70 years) patients with metastatic colorectal cancer (MCRC) is controversial. We performed a meta-analysis of published randomized studies.

Materials and methods

The selection of the studies was carried out using PubMed with the following keywords: “metastatic colorectal cancer,” “elderly,” “oxaliplatin,” “irinotecan,” “bevacizumab,” “survival.” The efficacy endpoints were overall survival (OS) and progression-free survival (PFS). Hazard ratios (HRs) with their 95% confidence intervals (CIs) were collected from the studies and pooled. By convention, an HR < 1 was a result in favor of biotherapy.

Results

This meta-analysis (MA) included ten studies: three assessing irinotecan (FFCD 2001–02, CAIRO, and an already published MA by Folprecht), three assessing oxaliplatin (FOCUS2, FFCD 2000–05, and a published study by De Gramont), and four assessing bevacizumab (PRODIGE-20, AVEX, AGITG-MAX, and “AVF2192g” by Kabbinavar). Our MA included 1652 patients (62% of men). Concerning age, we chose a cut-off of 70 years or a cut-off of 75 years, corresponding to the available data for each study. The performance index (PS) was 0–1 for about 90% of patients, with the exception of FFCD 2001–02 and FOCUS2 which included 30% of patients with PS2. Overall, the addition of bevacizumab to fluoropyrimidin statistically improves both OS and PFS (HR = 0.78; CI 0.63–0.96 and HR = 0.55; CI 0.44–0.67, respectively). The addition of oxaliplatin did not statistically improve OS (= 0.99; CI 0.85–1.17) but improves PFS (HR = 0.81; CI 0.67–0.97) as well as the addition of irinotecan (HR = 1.01; CI 0.84–1.22 and HR = 0.82; CI 0.68–1.00, respectively).

Conclusion

In previously untreated elderly patients with MCRC, the addition of bevacizumab to fluoropyrimidin appears more effective in terms of OS or PFS than the addition of oxaliplatin or irinotecan.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

★ PREMIUM-INHALT
e.Med Interdisziplinär

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Premium-Inhalten der Fachzeitschriften, inklusive eines Print-Abos.

Jetzt abonnieren und bis 25. Juni einen 50 € Amazon-Gutschein sichern.

Weitere Produktempfehlungen anzeigen
Literatur
Über diesen Artikel
  1. Das kostenlose Testabonnement läuft nach 14 Tagen automatisch und formlos aus. Dieses Abonnement kann nur einmal getestet werden.

  2. Das kostenlose Testabonnement läuft nach 14 Tagen automatisch und formlos aus. Dieses Abonnement kann nur einmal getestet werden.

Neu im Fachgebiet Chirurgie

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Chirurgie und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise