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Irinotecan/Fluorouracil Combination in First-Line Therapy of Older and Younger Patients With Metastatic Colorectal Cancer: Combined Analysis of 2,691 Patients in Randomized Controlled Trials

Gunnar Folprecht, Matthew T. Seymour, Leonard Saltz, Jean-Yves Douillard, Hartmut Hecker, Richard J. Stephens, Timothy S. Maughan, Eric Van Cutsem, Philippe Rougier, Emmanuel Mitry, Ute Schubert, Claus-Henning Köhne

From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium

Corresponding author: Gunnar Folprecht, MD, University Hospital Dresden, Fetscherstr 74, Dresden, Germany 01307; e-mail: gunnar.folprecht{at}uniklinikum-dresden.de

Purpose: Uncertainty exists about whether elderly patients benefit to the same extent as younger patients from combination therapy with irinotecan in the first-line treatment of metastatic colorectal cancer (CRC).

Patients and Methods: Combined analysis was carried out with source data from the fluorouracil (FU)/folinic acid (FA) and the irinotecan/FU/FA arms of four first-line, phase III trials of CRC to investigate the efficacy and safety of combination and monotherapy in elderly (age 70 years; n = 599) compared with younger (age < 70 years; n = 2,092) patients.

Results: Response rates were improved with irinotecan-based combination therapy compared with FU/FA in patients both younger than 70 years and 70 years (46.6% v 29.0% P < .0001; and 50.5% v 30.3%, P < .0001, respectively). With irinotecan/FU/FA, progression-free survival was better for both younger (hazard ratio [HR], 0.77; 95% CI, 0.70 to 0.85; P < .0001) and elderly patients (HR, 0.75; 95% CI, 0.61 to 0.90; P = .0026). In younger patients, overall survival was improved with combination therapy (HR, 0.83; 95% CI, 0.75 to 0.92; P = .0003). The same trend was observed in elderly patients (HR, 0.87; 95% CI, 0.72 to 1.05; P = .15). There was no significant interaction between treatment arm and age in the regression analysis. The expected differences in toxicity between combination and monotherapy in elderly and younger patients were observed. A significant interaction between treatment and age (cutoff, 70 years) for vomiting and hepatotoxicity was not confirmed by analysis that used age as a continuous variable.

Conclusion: Patients older than 70 years of age who were selected for inclusion in phase III trials derived similar benefits as younger patients from irinotecan-containing chemotherapy, and the risk of toxicity was similar.

Supported by Pfizer.

Presented at the 43rd Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, June 2-5, 2007.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.