By Pat Carragher - April 08, 2022
The number of patients with newly diagnosed metastatic colorectal cancer (mCRC) has been increasing in not only the aging population but also those under 50. According to researchers at Moffitt Cancer Center, age-related disparity in the management of patients with mCRC has not been adequately evaluated, until now.
In a new study presented at the 2022 American Association for Cancer Research Annual Meeting, researchers aimed to compare the treatment outcomes and adverse events among different age groups of patients with mCRC.
“We found that patients with early onset mCRC had worse overall survival which is very surprising,” said Dr. Hao Xie, an assistant member in the Department of Gastrointestinal Oncology and one of the study’s investigators. “We also found that these younger patients had higher incidence of some of the treatment related side effects.”
"We found that patients with early onset mCRC had worse overall survival which is very surprising. We also found that these younger patients had higher incidence of some of the treatment related side effects."- Dr. Hao Xie, Gastrointestinal Oncology
Researchers looked at clinical trial data for more than 900 mCRC patients who received the chemotherapy regimen FOLFOX or FOLFOX + panitumumab as a first-line therapy. Patients were grouped into three categories according to age: under 50, 50-65, and over 65.
“In my clinic, around 70% of patients are under 50. For this group of patients there are a lot of challenges for us to handle treatment,” said Xie. “This study will help us as oncologists individualize the care of patients with early onset mCRC.”
In both FOLFOX and FOLFOX + panitumumab treatment groups, patients under 50 had similar median overall survival to patients over 65. Both of those groups however, had significantly shorter median overall survival compared to patients ages 50-65.
What is FOLOX?FOLFOX is a chemotherapy regimen for treatment of colorectal cancer, made up of the drugs folinic acid, fluorouracil and oxaliplatin.
So why do younger mCRC patients tend to have worse outcomes?
“When you look at the gene mutations of this disease, there is not much difference between early onset and regular onset mCRC, so this data is very surprising,” said Xie. “For future direction of this project, in addition to mutations, we want to look at look at RNA expression, methylation, proteomics and the microbiome in this group of patients, so that we can eventually answer that question.”
When it comes to treatment-related side effects in the FOLFOX group, nausea and vomiting were more common in patients under 50 than their older counterparts. Patients under 50 also had earlier onset of neutropenia (low white blood cell count) and chest pain. In the FOLFOX + panitumumab group, patients under 50 experienced higher rates of fatigue, neuropathy and mucositis.
“Findings on the side effects were also surprising,” said Xie. “You would think the younger patients should tolerate treatment better than older patients, but that’s not the case. We found a lot of aspects of early onset patients that were similar to the elderly population.”
Research examining potential contributing factors like dietary habits and environmental exposure continues to be ongoing, but according to Xie, there have yet to be any significant statistical changes found.