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Efficacy and safety of FOLFIRI/aflibercept (FA) in an elderly population with metastatic colorectal cancer (mCRC) after failure of an oxaliplatin-based regimen.

AbstractBACKGROUND:
The VELOUR study showed the benefit of FOLFIRI-Aflibercept (FA) versus FOLFIRI in patients with metastatic colorectal cancer (mCRC) in second-line treatment. However, only 36% of the included patients were ≥65 years. Thus, we seek to evaluate the efficacy and safety of FA in the elderly population in the context of routine practice.
MATERIALS AND METHODS:
We conducted an observational, retrospective, multicenter, observational study of patients ≥70 years with mCRC treated with FA after progression to oxaliplatin chemotherapy in routine clinical practice in 9 hospitals of the GITuD group.
RESULTS:
Of 388 patients treated with FA between June 2013 and November 2018, 75 patients ≥70 years were included. The median number of cycles was 10 and the objective response (ORR) and disease control rates (DCR) were 33.8% and 72.0%, respectively. With a median follow-up of 27.1 months, median Progression-free survival (PFS) was 6.6 months and median Overall Survival (OS) was 15.1 months. One third fewer metastasectomies were performed in the ≥75 years' subgroup (24 vs. 52%, p = 0.024) and more initial FOLFIRI dose reductions (68 vs. 36%, p = 0.014). ORR (23.8% vs. 38.3%), DCR (42.8% vs. 85.1%), and PFS (4 vs. 7.8 months; p = 0.017) were significantly less, without difference in OS (9.9 vs. 17.1 months; p = 0.129). The presence of prior hypertension (HT) (PFS 7.9 vs. 5.7 months, p = 0.049) and HT ≥ grade 3 during treatment (PFS 7.6 vs. 6.6 months, p = 0.024) were associated with longer PFS. The most frequent grade 3/4 adverse events were: asthenia (21.3%), neutropenia (14.7%), and diarrhea (14.7%). 57.3% required FOLFIRI dose reduction; 34.7% of aflibercept, including discontinuation (5.3% and 18.7%, respectively).
CONCLUSIONS:
FA combination is effective in patients ≥70 years. The occurrence of HT is predictive of efficacy. Close monitoring of toxicity and initial dose adjustment is recommended.
AuthorsNieves Martínez-Lago, Soledad Cameselle García, Beatriz Alonso de Castro, Martín I Gómez-Randulfe Rodríguez, Marta Carmona Campos, Paula González Villarroel, Mercedes Salgado Fernández, Juan C De la Cámara Gómez, Carlos Romero Reinoso, Antía Cousillas Castiñeiras, José Carlos Méndez Méndez, Yolanda Vidal Insua, Ana Fernández-Montes
JournalPloS one (PLoS One) Vol. 17 Issue 6 Pg. e0269399 ( 2022) ISSN: 1932-6203 [Electronic] United States
PMID35657983 (Publication Type: Journal Article, Multicenter Study, Observational Study)
Chemical References
  • Recombinant Fusion Proteins
  • Oxaliplatin
  • aflibercept
  • Receptors, Vascular Endothelial Growth Factor
  • Leucovorin
  • Fluorouracil
  • Camptothecin
Topics
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols (adverse effects)
  • Camptothecin (adverse effects)
  • Colonic Neoplasms (drug therapy)
  • Colorectal Neoplasms (pathology)
  • Fluorouracil (adverse effects)
  • Humans
  • Leucovorin (adverse effects)
  • Oxaliplatin
  • Receptors, Vascular Endothelial Growth Factor (therapeutic use)
  • Recombinant Fusion Proteins (adverse effects)
  • Rectal Neoplasms (drug therapy)
  • Retrospective Studies

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