Bevacizumab plus chemotherapy in elderly patients with previously untreated metastatic colorectal cancer: single center experience
Background. Metastatic colorectal cancer (mCRC) is mainly a disease of elderly, however, geriatric population is underrepresented in clinical trials. Patient registries represent a tool to assess and follow treatment outcomes in this patient population.
Patients and methods. The registry of patients with mCRC was designed to prospectively evaluate the safety and efficacy of bevacizumab-containing chemotherapy (B-CTX) as well as selection of patients in routine clinical practice. Patient baseline clinical characteristics, pre-specified bevacizumab-related adverse events, and efficacy data were collected, evaluated and compared according to the age categories.
Results. Between January 2008 and December 2010, 210 patients with mCRC (median age 63, male 61.4%) started bevacizumab-containing therapy in the 1st line setting. Majority of the 210 patients received irinotecan-based chemotherapy (68%) as 1st line treatment and 105 patients (50%) received bevacizumab maintenance therapy. Elderly (≥70 years) patients presented 22.9% of all patients and they had worse performance status (PS1/2 62.4%) than patients in <70 years group (35.8%). Difference in disease control rate (DCR) was mainly due to inability to assess response in elderly group (64.6% in elderly and 77.8% in <70 years group, p=0.066). The median progression free survival (mPFS) was 10.2 (95% CI, 6.7 - 16.2) and 11.3 (95% CI, 10.2- 12.6) months in elderly and <70 years group, respectively (p=0.58). The median overall survival (mOS) was 18.5 (95% CI, 12.4 – 28.9) and 27.4 (95% CI, 22.7 - 31.9) months for elderly and <70 years group, respectively (p=0.03). Three-year survival rate was 26% and 37.6% in elderly vs. <70 years group. Overall rates of bevacizumab-related adverse events were similar in both groups: proteinuria 21/22 %, hypertension 25/19 %, haemorrhage 2/4 % and thromboembolic events 10/6 %, for elderly and <70 years group, respectively.
Conclusions. In routine clinical practice, the combination of bevacizumab and chemotherapy is effective and well-tolerated regimen in elderly patients with metastatic colorectal cancer.