Tolerability And Safety Of Cytotoxic Chemotherapy In Patients Over 80 With Colorectal Cancer (Crc) At Heart Of England Nhs Foundation Trust (Heft)

Introduction: Over half of all newly diagnosed cancers in the UK occur in patients over the age of 70. CRC, as with many cancers, is mainly a disease of elderly people. The median age at diagnosis is about 69 years, and 61% of patients are diagnosed at age 65 or older (1). There is a growing body of evidence to suggest that older people are under-treated (2). This is mainly due to the scarce data on chemotherapy tolerability and benefits in this growing population. Risks associated with old age should be taken into account when treatment options are considered, since elderly patients are more likely to present with multiple comorbidities and decline in organ function. We aimed to assess the safety and tolerability of chemotherapy in an exclusively elderly patient population (age >80) with CRC. Methods: Using a retrospective data set we analysed demographics, chemotherapy toxicities and early response rates of elderly patients receiving chemotherapy for CRC at HEFT over a period of 28 months. The cut off age was 80 years. Results: Between August 2010 and November 2013, 43 patients aged above 80 were diagnosed with CRC and referred for an oncological opinion. Of 34 patients deemed appropriate candidates for systemic treatment, 23 received chemotherapy, 1 underwent radiofrequency ablation, 7 are being managed on the ‘watch and wait approach’, and 2 declined treatment. The median age of patients who received chemotherapy was 82 years (Range 80 to 87). The majority had a WHO performance status of 0 or 1 but most patients had other comorbidities including hypertension (87%), joint problems (30%), ischaemic heart disease (17%) and arrhythmias (17%). Of the 23 patients who received chemotherapy, 35% were treated in the adjuvant setting and 66% in the palliative setting. Only 26.1% received combination chemotherapy whereas 73.9% had single agent treatment. 48% of patients completed the intended duration of treatment whilst treatment had to be discontinued early in 30%. 22% remained on active treatment at the time of analysis. Reasons for early cessation included disease progression (n= 4), toxicities (n = 3), comorbidities (n = 2) and patient choice (n = 2). Overall, 91% of patients experienced some form of treatment related toxicity, however only 2 patients were hospitalised as a result of chemotherapy. For patients who have completed 1st line treatment, the median overall duration of exposure to chemotherapy in the adjuvant group was 22 weeks and 15 weeks in the metastatic group. In the palliative group, 12 patients underwent restaging investigation. 33% achieved response and 17% stable disease whereas radiological evidence of progression occurred in 50%. Of those who relapsed, 4 patients received 2nd line therapy and 3 proceeded to 3rd line treatment. Conclusion: • Chemotherapy for CRC in the ≥80 population is well tolerated. However, most patients will require dose adjustments. A careful assessment is required to avoid both under- or over-treatment. • Our data demonstrated reasonable response rates in the metastatic setting confirming the benefit of treatment in this age group. • The use of formal geriatric and comorbidity assessments should be explored with further research.