Clinical Review Abstract
Trials in Progress Abstract
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Safety and efficacy of 90y resin microspheres in elderly (≥70 years) compared to younger patients with colorectal liver metastases (mCRC).
Gastrointestinal (Colorectal) Cancer
2013 ASCO Annual Meeting
J Clin Oncol 31, 2013 (suppl; abstr e14545)
Author(s): Andrew S. Kennedy, David Ball, Steven J. Cohen, Michael Cohn, Douglas M. Coldwell, Alain Drooz, Edward Ehrenwald, Samir Kanani, Fred M Moeslein, Charles W. Nutting, Samuel G. Putnam, Steven C. Rose, Michael Savin, Sabine Schirm, Navesh K Sharma, Eric Wang; Sarah Cannon Research Institute, Nashville, TN; Fox Chase Cancer Center, Philadelphia, PA; Radiology Associates of Hollywood, Pembroke Pines, FL; James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Fairfax Radiological Consultants, Fairfax, VA; Abbott Northwestern Hospital, Minneapolis, MN; Inova Fairfax Hospital, Annandale, VA; University of Maryland Medical Center, Baltimore, MD; Radiology Imaging Associates, Englewood, CO; UC San Diego Moores Cancer Center, La Jolla, CA; Beaumont Hospital, Royal Oak, MI; Cancer Centers of North Carolina, Cary, NC; University of Maryland School of Medicine, Baltimore, MD; Charlotte Radiology, Charlotte, NC
Background: The effects of advanced age on the clinical outcomes following 90Y treatment in elderly patients with mCRC are relatively unknown. Methods: A retrospective review was conducted to evaluate clinical outcomes among 160 elderly (≥70 years) and 446 younger (<70 years) patients with unresectable mCRC consecutively treated using 90Y resin microspheres (SIR-Spheres; Sirtex) from July 2002 to December 2011 at 11 US institutions. Data on background characteristics, prior chemotherapy or other procedures, 90Y therapy, subsequent adverse events and survival were documented. Results: The mean age (+ SD) of the elderly patients was 77.2 + 4.85 years and 55.9 + 9.45 years in the younger cohort. Regardless of age, patients receiving 90Y treatment were very similar in the elderly and younger cohorts in terms of sex, race, ECOG performance status and other characteristics. However, elderly patients were more likely to have had their primary resected (7.1% vs. 15.1%; p=0.009), received fewer lines of chemotherapy (p=0.036; 13.1% vs. 2.8% had no prior chemo, p<0.001), a longer period between diagnosis and 90Y therapy (median 26.9 vs. 20.5 months; p=0.011), and received only one 90Y treatment (58.8% vs. 46.4%; p=0.007). Overall survival following 90Y therapy did not deteriorate in elderly patients (median 9.3 vs. 9.7 months; p=0.335). 90Y treatment was equally well tolerated in both cohorts, with no significant increase in grade 3+ adverse events in elderly patients, but significantly fewer grade 1+ events for abdominal pain (26.3% vs. 41.3%; p<0.001) and nausea (20.6% vs. 29.4%; p=0.038). The most common grade 3+ events included: abdominal pain (3.1% vs. 6.1%), GI ulceration 0.6% vs. 1.3%), nausea (0.6% vs. 1.3%), vomiting (1.3% vs. 1.3%), fatigue (5.6% vs. 4.5%), ascites (1.3% vs. 2.0%), hyperbilirubinemia (3.8% vs. 2.7%) and anorexia (0.6% vs. 0.9%). Analysis of the 98 patients ≥75 years compared to younger patients confirmed equivalent outcomes for survival and toxicity. Conclusions: For patients with unresectable mCRC liver metastases that meet eligibility criteria, 90Y therapy appears to be as effective and well-tolerated for the elderly as it is for younger candidates.
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