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    Early-onset colorectal adenocarcinoma in the IDEA database: treatment adherence, toxicities, and outcomes with 3 and 6 months of adjuvant fluoropyrimidine and oxaliplatin

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    Authors
    Fontana, E.
    Meyers, J.
    Sobrero, A.
    Iveson, T.
    Shields, A. F.
    Taieb, J.
    Yoshino, T.
    Souglakos, I.
    Smyth, E. C.
    Lordick, F.
    Moehler, M.
    Giraut, A.
    Harkin, A.
    Labianca, R.
    Meyerhardt, J.
    André, T.
    Boukovinas, I.
    Lonardi, S.
    Saunders, Mark P
    Vernerey, D.
    Oki, E.
    Georgoulias, V.
    Ben-Aharon, I.
    Shi, Q.
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    Affiliation
    Sarah Cannon Research Institute UK, London, United Kingdom
    Issue Date
    2021
    
    Metadata
    Show full item record
    Abstract
    Purpose: Early-onset (EO) colorectal cancer (CRC, age < 50 years) incidence is increasing. Decisions on optimal adjuvant therapy should consider treatment adherence, adverse events, and expected outcomes in a population with life expectancy longer than later-onset (LO) CRC (age ≥ 50 years). Materials and methods: Individual patient data from six trials in the International Duration Evaluation of Adjuvant Chemotherapy database were analyzed. Characteristics, treatment adherence, and adverse events in stage II or III EO-CRC and LO-CRC were compared. To reduce confounders of non-cancer-related deaths because of age or comorbidities, time to recurrence (3-year relapse-free rate) and cancer-specific survival (5-year cancer-specific mortality rate) were considered. Results: Out of 16,349 patients, 1,564 (9.6%) had EO-CRC. Compared with LO-CRC, EO-CRC had better performance status (86% v 80%, P < .01), similar T stage (% T1-3/T4: 76/24 v 77/23, P = .97), higher N2 disease rate (24% v 22%, P < .01), more likely to complete the planned treatment duration (83.2% v 78.2%, P < .01), and received a higher treatment dose intensity, especially with 6-month regimens. Gastrointestinal toxicity was more common in EO-CRC; hematologic toxicity was more frequent in LO-CRC. Compared with LO-CRC, significantly worse cancer-specific outcomes were demonstrated especially in high-risk stage III EO-CRC: lower 3-year relapse-free rate (54% v 65%; hazard ratio [HR] 1.33; 95% CI, 1.14 to 1.55; P value < .001) and higher 5-year cancer-specific mortality rate (24% v 20%; HR 1.21; 95% CI, 1.00 to 1.47; P value < .06). In this subgroup, no difference was observed with 3 or 6 months of therapy, with equally poor disease-free survival rates (57% v 56%; HR 0.97; 95% CI, 0.73 to 1.29; P value = .85). Conclusion: Young age is negatively prognostic in high-risk stage III CRC and associated with significantly higher relapse rate; this is despite better treatment adherence and higher administered treatment intensity, suggesting more aggressive disease biology.
    Citation
    Fontana E, Meyers J, Sobrero A, Iveson T, Shields AF, Taieb J, et al. Early-Onset Colorectal Adenocarcinoma in the IDEA Database: Treatment Adherence, Toxicities, and Outcomes With 3 and 6 Months of Adjuvant Fluoropyrimidine and Oxaliplatin [Internet]. Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2021.
    Journal
    Journal of Clinical Oncology
    URI
    http://hdl.handle.net/10541/624770
    DOI
    10.1200/jco.21.02008
    PubMed ID
    34752136
    Additional Links
    https://dx.doi.org/10.1200/jco.21.02008
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1200/jco.21.02008
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