Metastatic Colorectal Cancer Outcomes by Age among ARCAD First- and Second-Line Clinical Trials

Nadine J. McCleary, William S. Harmsen, Ellana Haakenstad, James M. Cleary, Jeffrey A. Meyerhardt, John Zalcberg, Richard Adams, Axel Grothey, Alberto F. Sobrero, Eric Van Cutsem, Richard M. Goldberg, Marc Peeters, Josep Tabernero, Matt Seymour, Leonard B. Saltz, Bruce J. Giantonio, Dirk Arnold, Mace L. Rothenberg, Miriam Koopman, Hans Joachim SchmollHenry C. Pitot, Paulo M. Hoff, Niall Tebbutt, Gianluca Masi, John Souglakos, Carsten Bokemeyer, Volker Heinemann, Takayuki Yoshino, Benoist Chibaudel, Aimery Degramont, Qian Shi, Stuart M. S Lichtman

Research output: Contribution to journalArticlepeer-review


Background: We evaluated the time to progression (TTP) and survival outcomes of second-line therapy for metastatic colorectal cancer among adults aged 70 years and older compared with younger adults following progression on first-line clinical trials. Methods: Associations between clinical and disease characteristics, time to initial progression, and rate of receipt of second-line therapy were evaluated. TTP and overall survival (OS) were compared between older and younger adults in first- and second-line trials by Cox regression, adjusting for age, sex, Eastern Cooperative Oncology Group Performance Status, number of metastatic sites and presence of metastasis in the lung, liver, or peritoneum. All statistical tests were 2-sided. Results: Older adults comprised 16.4% of patients on first-line trials (870 total older adults aged >70 years; 4419 total younger adults aged ≤70 years, on first-line trials). Older adults and those with Eastern Cooperative Oncology Group Performance Status >0 were less likely to receive second-line therapy than younger adults. Odds of receiving second-line therapy decreased by 11% for each additional decade of life in multivariable analysis (odds ratio = 1.11, 95% confidence interval = 1.02 to 1.21, P =. 01). Older and younger adults enrolled in second-line trials experienced similar median TTP and median OS (median TTP = 5.1 vs 5.2 months, respectively; median OS = 11.6 vs 12.4 months, respectively). Conclusions: Older adults were less likely to receive second-line therapy for metastatic colorectal cancer, though we did not observe a statistical difference in survival outcomes vs younger adults following second-line therapy. Further study should examine factors affecting decisions to treat older adults with second-line therapy. Inclusion of geriatric assessment may provide better criteria regarding the risks and benefits of second-line therapy.

Original languageEnglish (US)
Article numberpkac014
JournalJNCI Cancer Spectrum
Issue number2
StatePublished - Apr 1 2022

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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