Randomized clinical trials have shown the treating patients with stage III colon cancer with chemotherapy, in addition to surgery, results in reductions in death and colon cancer recurrence. A pooled analysis of trials showed that the efficacy of fluorouracil-based chemotherapy regimens was similar in both older and younger patients. However, in practice, it seems that older patients with stage IIII colon cancer are much less likely to receive adjuvant chemotherapy.

According to research published in the March 17, 2010 issue of the Journal of the American Medical Association, among patients with stage III colon cancer who underwent surgical resection and received adjuvant chemotherapy, older colon cancer patients received less toxic and shorter chemotherapy regimens. They also had fewer adverse events than younger colon cancer patients. Researchers from the RAND Corporation performed an observational study of adjuvant chemotherapy use and outcomes among 675 patients with stage III colon cancer who underwent surgical resection. Only 50 percent of patients aged 75 years and older received adjuvant chemotherapy, as compared to 87 percent of younger patients. Older patients were also less likely to receive regimens containing oxaliplatin or lasting longer than 150 days.

Despite evidence that adjuvant chemotherapy is effective across the age spectrum in colon cancer, physicians may be reluctant to utilize standard chemotherapy in older patients due to comorbid conditions and drug toxicities. In this study, approximately 50 percent of older patients with stage III colon cancer received adjuvant chemotherapy, and doses and durations were lower than recommended based on clinical trial data. Further research is needed to determine whether this modified treatment affects survival and colon cancer recurrence rates.

Source:

JAMA 2010; 303(11): 1046-1053.