Bevacizumab-based first-line chemotherapy in elderly patients with metastatic colorectal cancer: an individual patient data based meta-analysis
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Christine Koch1, Anna M. Schwing1, Eva Herrmann2, Markus Borner3, Eduardo Diaz-Rubio4, Efrat Dotan5, Jaime Feliu6, Natsuko Okita7, John Souglakos8, Hendrik T. Arkenau9, Rainer Porschen10, Miriam Koopman11, Cornelis J.A. Punt12, Aimery de Gramont13, Christophe Tournigand14, Stefan Zeuzem1 and Joerg Trojan1
1Department of Gastroenterology, University Liver and Cancer Centre, Frankfurt, Germany
2Institute of Biostatistics and Mathematical Modelling, Johann Wolfgang Goethe-University, Frankfurt, Germany
3Medical Oncology Institute, Inselspital, Bern, Switzerland
4Department of Oncology, Hospital Clínico San Carlos, Madrid, Spain
5Fox Chase Cancer Center, Philadelphia, PA, USA
6Department of Medical Oncology, La Paz University Hospital, CIBERONC, Madrid, Spain
7National Cancer Center, Tokyo, Japan
8Department of Medical Oncology, University Hospital of Heraklion, University of Crete, Crete, Greece
9Sarah Cannon Research Institute, London, UK
10Klinikum Bremen Ost, Bremen, Germany
11Department of Medical Oncology, University Medical Centre, Utrecht, The Netherlands
12Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
13L’Institut Hospitalier Franco-Britannique, Paris, France
14University of Paris Est Creteil, Henri-Mondor Hospital, Créteil, France
Joerg Trojan, email: [email protected]
Keywords: metastatic colorectal cancer; elderly; first-line chemotherapy; bevacizumab
Received: June 12, 2017 Accepted: December 08, 2017 Published: December 20, 2017
Background: The aim of this meta-analysis was to evaluate efficacy and safety of first-line chemotherapy with or without a monoclonal antibody in elderly patients ( ≥ 70 years) with metastatic colorectal cancer (mCRC), since they are frequently underrepresented in clinical trials.
Results: Individual data from 10 studies were included. From a total of 3271 patients, 604 patients (18%) were ≥ 70 years (median 73 years, range 70–88). Of these, 335 patients were treated with a bevacizumab-based first-line regimen and 265 were treated with chemotherapy only. The median PFS was 8.2 vs. 6.5 months and the median OS was 16.7 vs. 13.0 months in patients treated with and without bevacizumab, respectively. The safety profile of bevacizumab in combination with first-line chemotherapy did not differ from published clinical trials.
Materials and Methods: PubMed and Cochrane Library searches were performed on 29 April 2013 and studies published to this date were included. Authors were contacted to request progression-free survival (PFS), overall survival (OS) data, patient data on treatment regimens, age, sex and potential signs of toxicity in patients ≥ 70 years of age.
Conclusions: This meta-analysis suggests that the addition of bevacizumab to standard first-line chemotherapy improves clinical outcome in elderly patients with mCRC and is well tolerated.
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