According to a recent article published in the
New England Journal of Medicine, pooled analyses involving over 3,000 patients confirm that elderly patients with colon cancer receive significant benefit from adjuvant chemotherapy with tolerability comparable to younger patients.
The colon is an important part of the body’s digestive system, consisting of the last few feet of the large intestine. The colon is an important part of the body’s digestive system, consisting of the last few feet of the large intestine. Stage II colon cancer (Dukes B) refers to cancer that has spread outside the colon wall to nearby structures with no spread to lymph nodes. Stage III colon cancer (Dukes C) refers to cancer that has spread from its site of origin to nearby lymph nodes, but without spread to distant sites in the body. Standard treatment options for stage III colon cancer may include surgery, chemotherapy, and/or radiation therapy.
Although the incidence of colon cancer is 11 times higher in patients over 65 compared to those who are younger, new treatment approaches evaluated in clinical trials often do not address elderly patients. Moreover, some physicians are reluctant to treat elderly patients in the same manner as their younger counterparts due to perceived intolerability of therapy. However, more clinical trials and retrospective analyses of data involving elderly patients are beginning to address the issue of survival benefits and tolerability of optimal treatment regimens in elderly patients who have cancer.
Previous clinical trials have demonstrated that adjuvant chemotherapy consisting of 5-fluorouracil and leucovorin reduces the risk of a cancer recurrence and cancer-related deaths following surgery by up to 30%. The concept behind the use of adjuvant therapy arises from the fact that current detection methods are not able to find or measure small amounts of cancer cells that may be left behind following surgery. These cancer cells are responsible for cancer recurrences. Chemotherapy is a systemic treatment, meaning its effects reach the entire body. This property enables chemotherapy to potentially kill undetectable cancer cells remaining in patients following surgery. However, research indicates that elderly patients with colon cancer often are not offered adjuvant chemotherapy as readily as younger patients, as physicians fear the risks of side effects may outweigh potential benefits for this group of patients.
Recently, researchers analyzed data from 7 separate clinical trials that were conducted to evaluate adjuvant chemotherapy in patients with stage II or III colon cancer. Patients were divided into four age groups: 50 years and younger, 51 to 60 years, 61 to 70 years and greater than 70 years. In these trials, patients received either surgery alone or surgery followed by adjuvant chemotherapy consisting of either 5-fluorouracil (5-FU) plus leucovorin or 5-FU plus levamisole. Five years following treatment, the overall survival rate was 71% for patients treated with adjuvant chemotherapy versus only 64% for those treated with surgery alone. There were no differences in survival rates between the age groups. The incidence of side effects from adjuvant chemotherapy was not increased in the elderly, except for one clinical trial reporting a higher rate of leukopenia (low white blood cell levels) in the elderly group.
The analysis from this large sum of data confirm that elderly patients with colon cancer who are in otherwise good health have improved survival with adjuvant chemotherapy and tolerate this treatment regimen as well as younger patients. Patients with colon cancer should speak with their physician about the risks and benefits of receiving adjuvant chemotherapy. (
New England Journal of Medicine, Vol 345, No. 15, pp 1091-1097, 2001)
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