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Poorer Survival in Stage III Early-Onset Colorectal Cancer
Colorectal cancer is increasing in younger patients, without obvious cause. Retrospective series suggest a worse outcome in younger patients, which may be stage dependent. Investigators for the International Duration Evaluation of Adjuvant Chemotherapy (IDEA) database report characteristics and outcomes for patients with early-onset (age <50 years) colorectal cancer (EO-CRC) compared with later-onset CRC (LO-CRC).
Of 16,349 patients enrolled in 6 clinical trials comparing 3 versus 6 months of adjuvant therapy, 1564 (9.6%) had EO-CRC. Patients with EO-CRC less often were male, more often had ECOG Performance Status of 0, and more often had distal primary tumors. A higher percentage of patients with EO-CRC than LO-CRC completed 6 months of therapy, but completion of 3 months of therapy was similar in the two groups. Nausea and vomiting were more common in EO-CRC, and hematologic toxicity was more common in LO-CRC.
Three-year disease-free survival (DFS) in the EO and LO groups was similar (76% and 78%; hazard ratio, 1.01; P=0.81) with no difference in stage II or III subgroups. However, 3-year relapse-free survival was lower in EO-CRC (75% vs. 79%; HR, 1.13; P=0.04), particularly in patients with stage III disease (69% vs. 76%; HR, 1.21; P=0.003) and in those with high-risk stage III disease (54% vs. 65%). Overall survival was higher in EO-CRC, likely due to younger age. Cancer-specific mortality (CSM) did not differ between EO and LO disease in those with stage II disease but was higher in EO-CRC among patients with stage III disease (5-year CSM, 15% vs. 12%; HR, 1.2; P=0.03), particularly in those with high-risk stage III disease (24% vs. 20%). Three months of therapy was inferior to 6 months only in patients with low-risk stage III EO-CRC (3-year DFS, 81% vs. 87%; HR, 1.49; P<0.05).
These results suggest a worse outcome in patients with EO-CRC compared to LO-CRC, particularly in those with high-risk stage III disease. The data support longer duration adjuvant therapy in patients with low-risk stage III disease. However, the report does not indicate outcomes by regimen (FOLFOX or capecitabine/oxaliplatin), and overall, IDEA data indicate 3 months of adjuvant capecitabine/oxaliplatin is acceptable therapy in low-risk stage III disease.
Fontana E et al.
Title: Early-onset colorectal adenocarcinoma in the IDEA database: Treatment adherence, toxicities, and outcomes with 3 and 6 months of adjuvant fluoropyrimidine and oxaliplatin.
Source: J Clin Oncol 2021 Dec 20; [e-pub]. (Abstract/FREE Full Text)