Ho Cheryl, Ng Kathy, O'Reilly Susan, Gill Sharlene
Division of Medical Oncology, British Columbia Cancer Agency, 600 W. 10th Avenue, Vancouver, BC, Canada V5Z 4E6.
Clin Colorectal Cancer. 2005 Nov;5(4):279-82. doi: 10.3816/ccc.2005.n.040.
Toxicity concerns impact the delivery of palliative chemotherapy to elderly patients with advanced colorectal cancer (CRC). Capecitabine was approved for funding in the province of British Columbia in the spring of 2002 as an oral chemotherapeutic option for metastatic CRC.
We conducted a population-based study to assess temporal trends in the use of systemic agents in elderly patients. Patients aged > or = 70 years with metastatic CRC diagnosed between January 1, 2000, and December 31, 2000, and between June 1, 2002, and May 31, 2003, were identified through the British Columbia Cancer Agency Registry. The time cohorts were before and after the provincial approval of capecitabine. Data were obtained regarding demographics, systemic therapies, and outcomes.
In cohort A, 35 of 89 patients (39%) were treated with chemotherapy. In the treated versus untreated groups of cohort A, 66% and 57% of patients were male, median ages were 73 years and 76 years, and liver metastasis was seen in 69% and 70% of patients, respectively. In cohort B, 36 of 78 patients (46%) were treated with systemic therapy. In the treated versus untreated groups of cohort B, 58% and 40% of patients were male, median ages were 75 years and 78.5 years, and liver metastasis was seen in 78% and 64% of patients. The most common first-line chemotherapy regimens used in cohort A included single-agent 5-FU in 66%, irinotecan-based regimens in 17%, and other regimens in 11%. First-line chemotherapy in cohort B included capecitabine in 47%, oxaliplatin-based regimens in 19%, and irinotecan-based regimens in 17%. The median times to treatment failure resulting from toxicity, disease progression, or death were 37 days in cohort A and 61 days in cohort B. Overall survival between the 2 time cohorts did not differ significantly. Toxicities resulting in dose delay and/or reduction were comparable.
We conclude that, in patients > or = 70 years of age with advanced CRC, single-agent 5-FU and capecitabine were the favored palliative regimens in British Columbia in 2000 and 2002, respectively. Capecitabine was well tolerated, and both treatments demonstrated similar survival. There was a trend observed toward a greater proportion of patients being offered systemic therapy in the 2002 cohort; however, the difference was not statistically significant.
毒性问题影响了晚期结直肠癌（CRC）老年患者姑息化疗的实施。卡培他滨于2002年春季在不列颠哥伦比亚省获批用于资助，作为转移性CRC的口服化疗选择。
我们开展了一项基于人群的研究，以评估老年患者全身用药的时间趋势。通过不列颠哥伦比亚癌症机构登记处，确定了2000年1月1日至2000年12月31日以及2002年6月1日至2003年5月31日期间诊断为转移性CRC且年龄≥70岁的患者。时间队列分为卡培他滨在该省获批之前和之后。获取了有关人口统计学、全身治疗及结局的数据。
在队列A中，89例患者中有35例（39%）接受了化疗。在队列A的治疗组与未治疗组中，男性患者分别占66%和57%，中位年龄分别为73岁和76岁，肝转移患者分别占69%和70%。在队列B中，78例患者中有36例（46%）接受了全身治疗。在队列B的治疗组与未治疗组中，男性患者分别占58%和40%，中位年龄分别为75岁和78.5岁，肝转移患者分别占78%和64%。队列A中最常用的一线化疗方案包括单药5-氟尿嘧啶（5-FU）占66%，基于伊立替康的方案占17%，其他方案占11%。队列B的一线化疗包括卡培他滨占47%，基于奥沙利铂的方案占19%，基于伊立替康的方案占17%。因毒性、疾病进展或死亡导致治疗失败的中位时间在队列A中为37天，在队列B中为61天。两个时间队列之间的总生存期无显著差异。导致剂量延迟和/或减少的毒性反应相当。
我们得出结论，在年龄≥70岁的晚期CRC患者中，单药5-FU和卡培他滨分别是2000年和2002年不列颠哥伦比亚省最常用的姑息治疗方案。卡培他滨耐受性良好，两种治疗方法的生存期相似。在2002年队列中观察到接受全身治疗的患者比例有增加趋势；然而，差异无统计学意义。
