Key clinical point: A higher dietary vitamin D intake was associated with reduced risk for colorectal cancer (CRC) and colon cancer in older individuals at high cardiovascular (CV) risk.

Major finding: After excluding individuals consuming vitamin D and/or calcium medication or prescribed supplements at baseline, those in highest vs. lowest quartile of vitamin D intake had 48% (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.28-0.96) and 56% (HR, 0.41; 95% CI, 0.12-0.85) lower risk of developing CRC and colon cancer alone, respectively.

Study details: Findings are from an analysis of 7,216 men and women aged between 55 and 80 years and at high CV risk from the PREvención con DIeta MEDiterránea study.

Disclosures: Spanish Instituto de Salud Carlos III (ISCIII) is funded by FEDER and supported by the official funding agency for biomedical research of the Spanish government, ISCIII, and others. J Salas‐Salvadó declared being a member of and receiving grants/research support, honoraria, and personal fees from various sources. The other authors declared no conflicts of interest.

Source: Hernández-Alonso P et al. Eur J Nutr. 2021 May 28. doi: 10.1007/s00394-021-02585-1.

Key clinical point: A higher dietary vitamin D intake was associated with reduced risk for colorectal cancer (CRC) and colon cancer in older individuals at high cardiovascular (CV) risk.

Major finding: After excluding individuals consuming vitamin D and/or calcium medication or prescribed supplements at baseline, those in highest vs. lowest quartile of vitamin D intake had 48% (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.28-0.96) and 56% (HR, 0.41; 95% CI, 0.12-0.85) lower risk of developing CRC and colon cancer alone, respectively.

Study details: Findings are from an analysis of 7,216 men and women aged between 55 and 80 years and at high CV risk from the PREvención con DIeta MEDiterránea study.

Disclosures: Spanish Instituto de Salud Carlos III (ISCIII) is funded by FEDER and supported by the official funding agency for biomedical research of the Spanish government, ISCIII, and others. J Salas‐Salvadó declared being a member of and receiving grants/research support, honoraria, and personal fees from various sources. The other authors declared no conflicts of interest.

Source: Hernández-Alonso P et al. Eur J Nutr. 2021 May 28. doi: 10.1007/s00394-021-02585-1.

Key clinical point: A higher dietary vitamin D intake was associated with reduced risk for colorectal cancer (CRC) and colon cancer in older individuals at high cardiovascular (CV) risk.

Major finding: After excluding individuals consuming vitamin D and/or calcium medication or prescribed supplements at baseline, those in highest vs. lowest quartile of vitamin D intake had 48% (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.28-0.96) and 56% (HR, 0.41; 95% CI, 0.12-0.85) lower risk of developing CRC and colon cancer alone, respectively.

Study details: Findings are from an analysis of 7,216 men and women aged between 55 and 80 years and at high CV risk from the PREvención con DIeta MEDiterránea study.

Disclosures: Spanish Instituto de Salud Carlos III (ISCIII) is funded by FEDER and supported by the official funding agency for biomedical research of the Spanish government, ISCIII, and others. J Salas‐Salvadó declared being a member of and receiving grants/research support, honoraria, and personal fees from various sources. The other authors declared no conflicts of interest.

Source: Hernández-Alonso P et al. Eur J Nutr. 2021 May 28. doi: 10.1007/s00394-021-02585-1.

Key clinical point: Obesity is a significant risk factor for colorectal cancer (CRC) in men with Lynch syndrome (LS). Moreover, obesity significantly increased CRC risk in patients with a mutation in mismatch repair gene MLH1.

Major finding: Obesity was associated with a significant 2-fold higher risk for CRC in men (summary relative risk [SRR], 2.09; 95% confidence interval [CI], 1.23-3.55) but not in women. Also, the mutation in MLH1 significantly increased the risk for CRC by 49% for every increase of 5 kg/m² (SRR, 1.49; 95% CI, 1.11-1.99).

Study details: Findings are from a meta-analysis of 4 observational studies that reported obesity and risk for CRC in patients with LS. The number of patients varied from 265 to 3,595.

Disclosures: This research received no external funding. The authors declared no conflicts of interest.

Source: Lazzeroni M et al. Nutrients. 2021 May 20. doi: 10.3390/nu13051736.

Key clinical point: Obesity is a significant risk factor for colorectal cancer (CRC) in men with Lynch syndrome (LS). Moreover, obesity significantly increased CRC risk in patients with a mutation in mismatch repair gene MLH1.

Major finding: Obesity was associated with a significant 2-fold higher risk for CRC in men (summary relative risk [SRR], 2.09; 95% confidence interval [CI], 1.23-3.55) but not in women. Also, the mutation in MLH1 significantly increased the risk for CRC by 49% for every increase of 5 kg/m² (SRR, 1.49; 95% CI, 1.11-1.99).

Study details: Findings are from a meta-analysis of 4 observational studies that reported obesity and risk for CRC in patients with LS. The number of patients varied from 265 to 3,595.

Disclosures: This research received no external funding. The authors declared no conflicts of interest.

Source: Lazzeroni M et al. Nutrients. 2021 May 20. doi: 10.3390/nu13051736.

Key clinical point: Obesity is a significant risk factor for colorectal cancer (CRC) in men with Lynch syndrome (LS). Moreover, obesity significantly increased CRC risk in patients with a mutation in mismatch repair gene MLH1.

Major finding: Obesity was associated with a significant 2-fold higher risk for CRC in men (summary relative risk [SRR], 2.09; 95% confidence interval [CI], 1.23-3.55) but not in women. Also, the mutation in MLH1 significantly increased the risk for CRC by 49% for every increase of 5 kg/m² (SRR, 1.49; 95% CI, 1.11-1.99).

Study details: Findings are from a meta-analysis of 4 observational studies that reported obesity and risk for CRC in patients with LS. The number of patients varied from 265 to 3,595.

Disclosures: This research received no external funding. The authors declared no conflicts of interest.

Source: Lazzeroni M et al. Nutrients. 2021 May 20. doi: 10.3390/nu13051736.

Key clinical point: Anlotinib was effective and tolerated in patients with refractory metastatic colorectal cancer (mCRC). Although overall survival (OS) did not reach statistical significance, anlotinib could still be clinically beneficial by substantially prolonged progression-free survival (PFS).

Major finding: Patients treated with anlotinib vs. placebo showed a significant 66% reduced risk for PFS (hazard ratio [HR], 0.34; P less than .0001); however, median OS was similar (HR, 1.02; P = .871). Hypertension (20.9%), increased γ-GT (7.1%), and hand-foot skin reaction (6.4%) were the most common anlotinib-related grade 3 or higher adverse events.

Study details: Findings are from the phase 3 ALTER0703 trial including 419 patients with mCRC who were randomly allocated to receive oral anlotinib (12 mg/day; n=282) or placebo (n=137) plus best supportive care.

Disclosures: The study was sponsored by Chia Tai Tianqing Pharmaceutical Group Co., Ltd.

Source: Chi Y et al. Oncologist. 2021 Jun 8. doi: 10.1002/onco.13857.

Key clinical point: Anlotinib was effective and tolerated in patients with refractory metastatic colorectal cancer (mCRC). Although overall survival (OS) did not reach statistical significance, anlotinib could still be clinically beneficial by substantially prolonged progression-free survival (PFS).

Major finding: Patients treated with anlotinib vs. placebo showed a significant 66% reduced risk for PFS (hazard ratio [HR], 0.34; P less than .0001); however, median OS was similar (HR, 1.02; P = .871). Hypertension (20.9%), increased γ-GT (7.1%), and hand-foot skin reaction (6.4%) were the most common anlotinib-related grade 3 or higher adverse events.

Study details: Findings are from the phase 3 ALTER0703 trial including 419 patients with mCRC who were randomly allocated to receive oral anlotinib (12 mg/day; n=282) or placebo (n=137) plus best supportive care.

Disclosures: The study was sponsored by Chia Tai Tianqing Pharmaceutical Group Co., Ltd.

Source: Chi Y et al. Oncologist. 2021 Jun 8. doi: 10.1002/onco.13857.

Key clinical point: Anlotinib was effective and tolerated in patients with refractory metastatic colorectal cancer (mCRC). Although overall survival (OS) did not reach statistical significance, anlotinib could still be clinically beneficial by substantially prolonged progression-free survival (PFS).

Major finding: Patients treated with anlotinib vs. placebo showed a significant 66% reduced risk for PFS (hazard ratio [HR], 0.34; P less than .0001); however, median OS was similar (HR, 1.02; P = .871). Hypertension (20.9%), increased γ-GT (7.1%), and hand-foot skin reaction (6.4%) were the most common anlotinib-related grade 3 or higher adverse events.

Study details: Findings are from the phase 3 ALTER0703 trial including 419 patients with mCRC who were randomly allocated to receive oral anlotinib (12 mg/day; n=282) or placebo (n=137) plus best supportive care.

Disclosures: The study was sponsored by Chia Tai Tianqing Pharmaceutical Group Co., Ltd.

Source: Chi Y et al. Oncologist. 2021 Jun 8. doi: 10.1002/onco.13857.

Key clinical point: Assessment of cumulative social risk can help identify patients with advanced colorectal cancer (CRC) at higher risk of omitting chemotherapy for nonclinical reasons. Systematic assessment of patients for social risk and a more holistic support program may encourage such patients to undergo their recommended chemotherapy regimen.

Major finding: Compared with participants with 0 social risk factors, those with 3 (odds ratio [OR], 0.48; P = .02) or more (6 or more; OR, 0.22; P = .001) risk factors were significantly less likely to receive planned chemotherapy. Those who reported 2 (OR, 3.05; P = .007) or more (6 or more sources; OR, 5.95; P less than .001) sources of social support were more likely to receive chemotherapy than participants with no social support.

Study details: Findings are from a cross-sectional, population-based survey of 1,087 adults diagnosed with stage III CRC.

Disclosures: The study was supported by a research scholar grant from the American Cancer Society. Dr. Abrahamse, Dr. Kato, and Dr. Ward reported receiving grants from various sources.

Source: Davis RE et al. JAMA Netw Open. 2021 Jun 1. doi: 10.1001/jamanetworkopen.2021.13533.

Key clinical point: Assessment of cumulative social risk can help identify patients with advanced colorectal cancer (CRC) at higher risk of omitting chemotherapy for nonclinical reasons. Systematic assessment of patients for social risk and a more holistic support program may encourage such patients to undergo their recommended chemotherapy regimen.

Major finding: Compared with participants with 0 social risk factors, those with 3 (odds ratio [OR], 0.48; P = .02) or more (6 or more; OR, 0.22; P = .001) risk factors were significantly less likely to receive planned chemotherapy. Those who reported 2 (OR, 3.05; P = .007) or more (6 or more sources; OR, 5.95; P less than .001) sources of social support were more likely to receive chemotherapy than participants with no social support.

Study details: Findings are from a cross-sectional, population-based survey of 1,087 adults diagnosed with stage III CRC.

Disclosures: The study was supported by a research scholar grant from the American Cancer Society. Dr. Abrahamse, Dr. Kato, and Dr. Ward reported receiving grants from various sources.

Source: Davis RE et al. JAMA Netw Open. 2021 Jun 1. doi: 10.1001/jamanetworkopen.2021.13533.

Key clinical point: Assessment of cumulative social risk can help identify patients with advanced colorectal cancer (CRC) at higher risk of omitting chemotherapy for nonclinical reasons. Systematic assessment of patients for social risk and a more holistic support program may encourage such patients to undergo their recommended chemotherapy regimen.

Major finding: Compared with participants with 0 social risk factors, those with 3 (odds ratio [OR], 0.48; P = .02) or more (6 or more; OR, 0.22; P = .001) risk factors were significantly less likely to receive planned chemotherapy. Those who reported 2 (OR, 3.05; P = .007) or more (6 or more sources; OR, 5.95; P less than .001) sources of social support were more likely to receive chemotherapy than participants with no social support.

Study details: Findings are from a cross-sectional, population-based survey of 1,087 adults diagnosed with stage III CRC.

Disclosures: The study was supported by a research scholar grant from the American Cancer Society. Dr. Abrahamse, Dr. Kato, and Dr. Ward reported receiving grants from various sources.

Source: Davis RE et al. JAMA Netw Open. 2021 Jun 1. doi: 10.1001/jamanetworkopen.2021.13533.

Key clinical point: HLX04, a potential bevacizumab biosimilar, demonstrated efficacy equivalence with reference bevacizumab with comparable safety and immunogenicity in patients with recurrent/metastatic colorectal cancer (CRC).

Major finding: The progression-free survival rate at week 36 in HLX04 vs. bevacizumab group was 46.4% vs. 50.7% leading to rate difference (4.2%; 90% confidence interval [CI], −10.6 to 2.1) and rate ratio (0.92; 90% CI, 0.80 to −1.05) within the prespecified equivalence margins. Grade 3 or higher treatment-emergent adverse events were reported by 65.5% vs. 70.6% of patients in the HLX04 vs. bevacizumab group. Detection of antidrug and neutralizing antibodies was comparable.

Study details: Findings are from a phase 3 equivalence study including 677 patients with recurrent/metastatic CRC randomly allocated to either HLX04 or reference bevacizumab in combination with modified FOLFOX6 or XELOX.

Disclosures: The study was sponsored by the Shanghai Henlius Biotech, Inc. W Kang declared being an employee of Shanghai Henlius Biotech, Inc. The other authors declared having no directly relevant conflicts of interest.

Source: Qin S et al. BioDrugs. 2021 May 20. doi: 10.1007/s40259-021-00484-9.

Key clinical point: HLX04, a potential bevacizumab biosimilar, demonstrated efficacy equivalence with reference bevacizumab with comparable safety and immunogenicity in patients with recurrent/metastatic colorectal cancer (CRC).

Major finding: The progression-free survival rate at week 36 in HLX04 vs. bevacizumab group was 46.4% vs. 50.7% leading to rate difference (4.2%; 90% confidence interval [CI], −10.6 to 2.1) and rate ratio (0.92; 90% CI, 0.80 to −1.05) within the prespecified equivalence margins. Grade 3 or higher treatment-emergent adverse events were reported by 65.5% vs. 70.6% of patients in the HLX04 vs. bevacizumab group. Detection of antidrug and neutralizing antibodies was comparable.

Study details: Findings are from a phase 3 equivalence study including 677 patients with recurrent/metastatic CRC randomly allocated to either HLX04 or reference bevacizumab in combination with modified FOLFOX6 or XELOX.

Disclosures: The study was sponsored by the Shanghai Henlius Biotech, Inc. W Kang declared being an employee of Shanghai Henlius Biotech, Inc. The other authors declared having no directly relevant conflicts of interest.

Source: Qin S et al. BioDrugs. 2021 May 20. doi: 10.1007/s40259-021-00484-9.

Key clinical point: HLX04, a potential bevacizumab biosimilar, demonstrated efficacy equivalence with reference bevacizumab with comparable safety and immunogenicity in patients with recurrent/metastatic colorectal cancer (CRC).

Major finding: The progression-free survival rate at week 36 in HLX04 vs. bevacizumab group was 46.4% vs. 50.7% leading to rate difference (4.2%; 90% confidence interval [CI], −10.6 to 2.1) and rate ratio (0.92; 90% CI, 0.80 to −1.05) within the prespecified equivalence margins. Grade 3 or higher treatment-emergent adverse events were reported by 65.5% vs. 70.6% of patients in the HLX04 vs. bevacizumab group. Detection of antidrug and neutralizing antibodies was comparable.

Study details: Findings are from a phase 3 equivalence study including 677 patients with recurrent/metastatic CRC randomly allocated to either HLX04 or reference bevacizumab in combination with modified FOLFOX6 or XELOX.

Disclosures: The study was sponsored by the Shanghai Henlius Biotech, Inc. W Kang declared being an employee of Shanghai Henlius Biotech, Inc. The other authors declared having no directly relevant conflicts of interest.

Source: Qin S et al. BioDrugs. 2021 May 20. doi: 10.1007/s40259-021-00484-9.

Key clinical point: Findings from this phase 2 trial support feasibility and safety of perioperative systemic therapy in patients with resectable colorectal peritoneal metastases (CPM).

Major finding: The proportion of patients undergoing macroscopic complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC; risk ratio, 1.04; P = .74) and with Clavien-Dindo grade 3 or higher postoperative morbidity (risk ratio, 0.65; P = .25) was not significantly different between the perioperative systemic therapy and CRS-HIPEC alone arms.

Study details: Findings are from CAIRO6, a phase 2-superiority trial that included 79 patients with resectable CPM who were randomly allocated to either perioperative systemic therapy or CRS-HIPEC alone.

Disclosures: The study was funded by the Dutch Cancer Society and F. Hoffmann-La Roche. Dr. Koopman, Dr. Punt, Dr. Tanis, and Dr. de Hingh reported serving as a paid advisor and/or receiving grants from various sources. No other disclosures were reported.

Source: KP Rovers et al. JAMA Surg. 2021 May 19. doi: 10.1001/jamasurg.2021.1642.

Key clinical point: Findings from this phase 2 trial support feasibility and safety of perioperative systemic therapy in patients with resectable colorectal peritoneal metastases (CPM).

Major finding: The proportion of patients undergoing macroscopic complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC; risk ratio, 1.04; P = .74) and with Clavien-Dindo grade 3 or higher postoperative morbidity (risk ratio, 0.65; P = .25) was not significantly different between the perioperative systemic therapy and CRS-HIPEC alone arms.

Study details: Findings are from CAIRO6, a phase 2-superiority trial that included 79 patients with resectable CPM who were randomly allocated to either perioperative systemic therapy or CRS-HIPEC alone.

Disclosures: The study was funded by the Dutch Cancer Society and F. Hoffmann-La Roche. Dr. Koopman, Dr. Punt, Dr. Tanis, and Dr. de Hingh reported serving as a paid advisor and/or receiving grants from various sources. No other disclosures were reported.

Source: KP Rovers et al. JAMA Surg. 2021 May 19. doi: 10.1001/jamasurg.2021.1642.

Key clinical point: Findings from this phase 2 trial support feasibility and safety of perioperative systemic therapy in patients with resectable colorectal peritoneal metastases (CPM).

Major finding: The proportion of patients undergoing macroscopic complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC; risk ratio, 1.04; P = .74) and with Clavien-Dindo grade 3 or higher postoperative morbidity (risk ratio, 0.65; P = .25) was not significantly different between the perioperative systemic therapy and CRS-HIPEC alone arms.

Study details: Findings are from CAIRO6, a phase 2-superiority trial that included 79 patients with resectable CPM who were randomly allocated to either perioperative systemic therapy or CRS-HIPEC alone.

Disclosures: The study was funded by the Dutch Cancer Society and F. Hoffmann-La Roche. Dr. Koopman, Dr. Punt, Dr. Tanis, and Dr. de Hingh reported serving as a paid advisor and/or receiving grants from various sources. No other disclosures were reported.

Source: KP Rovers et al. JAMA Surg. 2021 May 19. doi: 10.1001/jamasurg.2021.1642.

Key clinical point: Screening lower gastrointestinal tract endoscopy in adults older than 75 years with no substantial comorbidities was associated with a lower risk for colorectal cancer (CRC) incidence and survival gain, regardless of screening history.

Major finding: Irrespective of prior screening history, endoscopic screening after 75 years of age was associated with a significantly lower incidence of CRC (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.51-0.74) and CRC-related mortality (HR, 0.60; 95% CI, 0.46-0.78), particularly in individuals without cardiovascular diseases or substantial comorbidities.

Study details: Findings are from an analysis of 2 prospective cohorts of 56,374 U.S. adults who reached 75 years of age during follow-up.

Disclosures: The study was supported by grants from the National Institutes of Health, a Stuart and Suzanne Steele Massachusetts General Hospital (MGH) Research Scholar award (Dr. Chan), and an MGH Executive Committee on Research Tosteson and Fund for Medical Discovery Postdoctoral Fellowship award (Dr. Ma). Dr. Nishihara and Dr. Chan reported holding stocks and/or consulting for various sources.

Source: Ma W et al. JAMA Oncol. 2021 May 20. doi: 10.1001/jamaoncol.2021.1364.

Key clinical point: Screening lower gastrointestinal tract endoscopy in adults older than 75 years with no substantial comorbidities was associated with a lower risk for colorectal cancer (CRC) incidence and survival gain, regardless of screening history.

Major finding: Irrespective of prior screening history, endoscopic screening after 75 years of age was associated with a significantly lower incidence of CRC (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.51-0.74) and CRC-related mortality (HR, 0.60; 95% CI, 0.46-0.78), particularly in individuals without cardiovascular diseases or substantial comorbidities.

Study details: Findings are from an analysis of 2 prospective cohorts of 56,374 U.S. adults who reached 75 years of age during follow-up.

Disclosures: The study was supported by grants from the National Institutes of Health, a Stuart and Suzanne Steele Massachusetts General Hospital (MGH) Research Scholar award (Dr. Chan), and an MGH Executive Committee on Research Tosteson and Fund for Medical Discovery Postdoctoral Fellowship award (Dr. Ma). Dr. Nishihara and Dr. Chan reported holding stocks and/or consulting for various sources.

Source: Ma W et al. JAMA Oncol. 2021 May 20. doi: 10.1001/jamaoncol.2021.1364.

Key clinical point: Screening lower gastrointestinal tract endoscopy in adults older than 75 years with no substantial comorbidities was associated with a lower risk for colorectal cancer (CRC) incidence and survival gain, regardless of screening history.

Major finding: Irrespective of prior screening history, endoscopic screening after 75 years of age was associated with a significantly lower incidence of CRC (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.51-0.74) and CRC-related mortality (HR, 0.60; 95% CI, 0.46-0.78), particularly in individuals without cardiovascular diseases or substantial comorbidities.

Study details: Findings are from an analysis of 2 prospective cohorts of 56,374 U.S. adults who reached 75 years of age during follow-up.

Disclosures: The study was supported by grants from the National Institutes of Health, a Stuart and Suzanne Steele Massachusetts General Hospital (MGH) Research Scholar award (Dr. Chan), and an MGH Executive Committee on Research Tosteson and Fund for Medical Discovery Postdoctoral Fellowship award (Dr. Ma). Dr. Nishihara and Dr. Chan reported holding stocks and/or consulting for various sources.

Source: Ma W et al. JAMA Oncol. 2021 May 20. doi: 10.1001/jamaoncol.2021.1364.

Choice of chemotherapy in metastatic colorectal cancer (mCRC): Age alone should not matter!

Consideration for chemotherapy in patients who are older has been limited to less intensive regimens. A recent study by Davis et al assessing the association of cumulative social risk and social support with receipt of chemotherapy among patients with mCRC confirmed that close to 40% of patients may not receive chemotherapy. Older age (≥65 years) was associated with a lower likelihood of chemotherapy receipt with an odds ratio (OR) of 0.28. Additional social risk (such as gender and/or race) further decreased the risk for not receiving chemotherapy. Identifying patients at risk and targeting them with patient support programs may help them with undergoing recommended treatment as per guidelines. The data from this study suggest that support from family and friends is beneficial and may allow patients to complete their chemotherapy treatment and consequently improve their long-term outcomes. In the absence of such support, any other source of support can mitigate the risk of nontreatment and should be strongly considered.

The study by Nakayama et al not only confirms the benefits of treating older patients but also shows evidence that those older than 80 years appear to derive a very similar benefit as younger patients with more intense chemotherapy. In this group of patients, intensive chemotherapy was defined as at least 2 courses of doublet chemotherapy with oxaliplatin- or irinotecan-based treatment. The results suggest a very similar survival outcomes for the aged and the younger patient groups with a hazard ratio (HR) of 1.29. Overall, this study suggests that older patients, including those older than 80 years, who may be eligible for intensive chemotherapy should not be excluded from this consideration based on their age alone. The option for intensive chemotherapy allows for eligible older patients to be exposed to a continuum of life extending therapies similar to younger patients.  Indeed, a recent prospective phase II study by Takahashi et al confirmed that trifluridine/tipiracil (FTD/TPI) was effective and well tolerated in elderly patients with mCRC and is in line with similar benefits historically observed in younger patients.

In conclusion, the cumulative knowledge from these studies confirms that identifying proper social support to older patients with mCRC will ensure that they are able to receive chemotherapy as indicated. It is also important to emphasize that age itself should not be a discriminator against the use of intensive chemotherapy and the opportunity to be exposed to the continuum of treatment options as indicated. It is understandable that for those older patients who may not be eligible for intensive chemotherapy, consideration for less intense therapy has been well validated in the past. At any point of the treatment continuum, as with any part of our oncologic care, discussion with patients and shared decision making is key to preserving the sacrosanct principles of patient autonomy and do no harm.

Choice of chemotherapy in metastatic colorectal cancer (mCRC): Age alone should not matter!

Consideration for chemotherapy in patients who are older has been limited to less intensive regimens. A recent study by Davis et al assessing the association of cumulative social risk and social support with receipt of chemotherapy among patients with mCRC confirmed that close to 40% of patients may not receive chemotherapy. Older age (≥65 years) was associated with a lower likelihood of chemotherapy receipt with an odds ratio (OR) of 0.28. Additional social risk (such as gender and/or race) further decreased the risk for not receiving chemotherapy. Identifying patients at risk and targeting them with patient support programs may help them with undergoing recommended treatment as per guidelines. The data from this study suggest that support from family and friends is beneficial and may allow patients to complete their chemotherapy treatment and consequently improve their long-term outcomes. In the absence of such support, any other source of support can mitigate the risk of nontreatment and should be strongly considered.

The study by Nakayama et al not only confirms the benefits of treating older patients but also shows evidence that those older than 80 years appear to derive a very similar benefit as younger patients with more intense chemotherapy. In this group of patients, intensive chemotherapy was defined as at least 2 courses of doublet chemotherapy with oxaliplatin- or irinotecan-based treatment. The results suggest a very similar survival outcomes for the aged and the younger patient groups with a hazard ratio (HR) of 1.29. Overall, this study suggests that older patients, including those older than 80 years, who may be eligible for intensive chemotherapy should not be excluded from this consideration based on their age alone. The option for intensive chemotherapy allows for eligible older patients to be exposed to a continuum of life extending therapies similar to younger patients.  Indeed, a recent prospective phase II study by Takahashi et al confirmed that trifluridine/tipiracil (FTD/TPI) was effective and well tolerated in elderly patients with mCRC and is in line with similar benefits historically observed in younger patients.

In conclusion, the cumulative knowledge from these studies confirms that identifying proper social support to older patients with mCRC will ensure that they are able to receive chemotherapy as indicated. It is also important to emphasize that age itself should not be a discriminator against the use of intensive chemotherapy and the opportunity to be exposed to the continuum of treatment options as indicated. It is understandable that for those older patients who may not be eligible for intensive chemotherapy, consideration for less intense therapy has been well validated in the past. At any point of the treatment continuum, as with any part of our oncologic care, discussion with patients and shared decision making is key to preserving the sacrosanct principles of patient autonomy and do no harm.

Choice of chemotherapy in metastatic colorectal cancer (mCRC): Age alone should not matter!

Consideration for chemotherapy in patients who are older has been limited to less intensive regimens. A recent study by Davis et al assessing the association of cumulative social risk and social support with receipt of chemotherapy among patients with mCRC confirmed that close to 40% of patients may not receive chemotherapy. Older age (≥65 years) was associated with a lower likelihood of chemotherapy receipt with an odds ratio (OR) of 0.28. Additional social risk (such as gender and/or race) further decreased the risk for not receiving chemotherapy. Identifying patients at risk and targeting them with patient support programs may help them with undergoing recommended treatment as per guidelines. The data from this study suggest that support from family and friends is beneficial and may allow patients to complete their chemotherapy treatment and consequently improve their long-term outcomes. In the absence of such support, any other source of support can mitigate the risk of nontreatment and should be strongly considered.

The study by Nakayama et al not only confirms the benefits of treating older patients but also shows evidence that those older than 80 years appear to derive a very similar benefit as younger patients with more intense chemotherapy. In this group of patients, intensive chemotherapy was defined as at least 2 courses of doublet chemotherapy with oxaliplatin- or irinotecan-based treatment. The results suggest a very similar survival outcomes for the aged and the younger patient groups with a hazard ratio (HR) of 1.29. Overall, this study suggests that older patients, including those older than 80 years, who may be eligible for intensive chemotherapy should not be excluded from this consideration based on their age alone. The option for intensive chemotherapy allows for eligible older patients to be exposed to a continuum of life extending therapies similar to younger patients.  Indeed, a recent prospective phase II study by Takahashi et al confirmed that trifluridine/tipiracil (FTD/TPI) was effective and well tolerated in elderly patients with mCRC and is in line with similar benefits historically observed in younger patients.

In conclusion, the cumulative knowledge from these studies confirms that identifying proper social support to older patients with mCRC will ensure that they are able to receive chemotherapy as indicated. It is also important to emphasize that age itself should not be a discriminator against the use of intensive chemotherapy and the opportunity to be exposed to the continuum of treatment options as indicated. It is understandable that for those older patients who may not be eligible for intensive chemotherapy, consideration for less intense therapy has been well validated in the past. At any point of the treatment continuum, as with any part of our oncologic care, discussion with patients and shared decision making is key to preserving the sacrosanct principles of patient autonomy and do no harm.

Key clinical point: For HCC patients treated with DEB-TACE, size or concentration of microspheres did not affect overall survival, but doxorubicin concentration did impact factors including treatment response and hospital stay.

Major finding: A total of 23 patients achieved complete response (CR), 32 achieved a partial response, 18 had stable disease, and 14 had progressive disease; no difference in treatment response was noted between 75-µm and 100-µm groups, but patients treated with half-loaded doxorubicin had significantly higher CR (53.3% vs 20.8%) and shorter hospital stays (1.7 days vs. 2.2 days) than patients treated with full-loaded doxorubicin.

Study details: The data come from a retrospective study of 87 adults with HCC who underwent drug-eluting bead transarterial chemoembolization (DEB-TACE) with half-loaded or full-loaded doxorubicin in 75-µm or 100-µm microspheres.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Lin C-Y et al. Sci Rep. 2021 Jun 10. doi: 10.1038/s41598-021-91021-9.

Key clinical point: For HCC patients treated with DEB-TACE, size or concentration of microspheres did not affect overall survival, but doxorubicin concentration did impact factors including treatment response and hospital stay.

Major finding: A total of 23 patients achieved complete response (CR), 32 achieved a partial response, 18 had stable disease, and 14 had progressive disease; no difference in treatment response was noted between 75-µm and 100-µm groups, but patients treated with half-loaded doxorubicin had significantly higher CR (53.3% vs 20.8%) and shorter hospital stays (1.7 days vs. 2.2 days) than patients treated with full-loaded doxorubicin.

Study details: The data come from a retrospective study of 87 adults with HCC who underwent drug-eluting bead transarterial chemoembolization (DEB-TACE) with half-loaded or full-loaded doxorubicin in 75-µm or 100-µm microspheres.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Lin C-Y et al. Sci Rep. 2021 Jun 10. doi: 10.1038/s41598-021-91021-9.

Key clinical point: For HCC patients treated with DEB-TACE, size or concentration of microspheres did not affect overall survival, but doxorubicin concentration did impact factors including treatment response and hospital stay.

Major finding: A total of 23 patients achieved complete response (CR), 32 achieved a partial response, 18 had stable disease, and 14 had progressive disease; no difference in treatment response was noted between 75-µm and 100-µm groups, but patients treated with half-loaded doxorubicin had significantly higher CR (53.3% vs 20.8%) and shorter hospital stays (1.7 days vs. 2.2 days) than patients treated with full-loaded doxorubicin.

Study details: The data come from a retrospective study of 87 adults with HCC who underwent drug-eluting bead transarterial chemoembolization (DEB-TACE) with half-loaded or full-loaded doxorubicin in 75-µm or 100-µm microspheres.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Lin C-Y et al. Sci Rep. 2021 Jun 10. doi: 10.1038/s41598-021-91021-9.

Key clinical point: Overall survival rates were similar in patients with intrahepatic cholangiocarcinoma (iCCA) and hepatocellular carcinoma (HCC) in a multivariate analysis. However, iCCA patients had better overall survival in a subgroup analysis of patients with poor prognostic features such as tumor size and lymph node involvement.

Major finding: Overall survival was 9 months for iCCA vs. 13 months for HCC, but this difference lost significance in multivariate analysis. In a subgroup analysis, overall survival was greater in iCCA compared to HCC for patients with tumors of 5 cm or larger (adjusted hazard ratio 0.83), lymph node involvement (aHR 0.76), distant metastasis (aHR 0.76), poorly/undifferentiated tumors (aHR 0.88) and patients receiving non-curative treatment (aHR 0.96).

Study details: The data come from the Surveillance, Epidemiology, and End Results Program 18 Database (2000-2017), and the study population included 13,611 iCCA patients and 96,151 HCC patients. 

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose

Source: Lee Y-T et al. Hepatology. 2021 Jun 11. doi: 10.1002/hep.32007.

Key clinical point: Overall survival rates were similar in patients with intrahepatic cholangiocarcinoma (iCCA) and hepatocellular carcinoma (HCC) in a multivariate analysis. However, iCCA patients had better overall survival in a subgroup analysis of patients with poor prognostic features such as tumor size and lymph node involvement.

Major finding: Overall survival was 9 months for iCCA vs. 13 months for HCC, but this difference lost significance in multivariate analysis. In a subgroup analysis, overall survival was greater in iCCA compared to HCC for patients with tumors of 5 cm or larger (adjusted hazard ratio 0.83), lymph node involvement (aHR 0.76), distant metastasis (aHR 0.76), poorly/undifferentiated tumors (aHR 0.88) and patients receiving non-curative treatment (aHR 0.96).

Study details: The data come from the Surveillance, Epidemiology, and End Results Program 18 Database (2000-2017), and the study population included 13,611 iCCA patients and 96,151 HCC patients. 

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose

Source: Lee Y-T et al. Hepatology. 2021 Jun 11. doi: 10.1002/hep.32007.

Key clinical point: Overall survival rates were similar in patients with intrahepatic cholangiocarcinoma (iCCA) and hepatocellular carcinoma (HCC) in a multivariate analysis. However, iCCA patients had better overall survival in a subgroup analysis of patients with poor prognostic features such as tumor size and lymph node involvement.

Major finding: Overall survival was 9 months for iCCA vs. 13 months for HCC, but this difference lost significance in multivariate analysis. In a subgroup analysis, overall survival was greater in iCCA compared to HCC for patients with tumors of 5 cm or larger (adjusted hazard ratio 0.83), lymph node involvement (aHR 0.76), distant metastasis (aHR 0.76), poorly/undifferentiated tumors (aHR 0.88) and patients receiving non-curative treatment (aHR 0.96).

Study details: The data come from the Surveillance, Epidemiology, and End Results Program 18 Database (2000-2017), and the study population included 13,611 iCCA patients and 96,151 HCC patients. 

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose

Source: Lee Y-T et al. Hepatology. 2021 Jun 11. doi: 10.1002/hep.32007.