Older versus younger patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction, and stomach: A pooled analysis of eight consecutive North Central Cancer Treatment Group (NCCTG)

Whether elderly patients with metastatic esophageal, gastroesophageal, and gastric cancer do as well with chemotherapy as their younger counterparts was investigated in this pooled analysis. In total, 367 patients from 8 consecutive, first-line trials were included: i) etoposide + cisplatin; ii) 5-fluorourucil + leucovorin; iii) 5fluorouracil + levamisole; iv) irinotecan; v) docetaxel + irinotecan; vi) oxaliplatin + capecitabine; vii) docetaxel + capecitabine; and viii) bortezomib + paclitaxel + carboplatin. One hundred and fifty-four (42%) patients were ≥65 years old (range: 65-86), and 213 younger (range: 20-64). Elderly patients had worse performance scores (2-3): 19 vs. 8% (p<0.0001). Rates of grade 3+ adverse events across all chemotherapy cycles in univariate and multivariate analyses (adjusted for gender, performance score, and stratified by individual study) were higher among elderly patients. Rates of neutropenia, fatigue, infection, and stomatitis in elderly vs. younger patients were 31 vs. 29% (p=0.02 by multivariate analyses); 15 vs. 5% (p=0.01); 9 vs. 4% (p=0.03); 6 vs. 1% (p=0.04). In contrast, duration of chemotherapy, overall survival, and progression-free survival were comparable. Although age should not preclude trial entry, these adverse event rates suggest a need to develop more tolerable regimens for older patients with these malignancies. Introduction Cancer occurs predominantly in older patients (1). The demographics surrounding esophageal, gastroesophageal, and gastric cancer offer no exception to this observation. These cancers occur predominantly in patients who are older than 65 years of age (2), and, over time, the age-specific incidence of these malignancies has shifted towards the elderly (2). Thus, it becomes increasingly more important to understand how best to treat elderly patients who develop adenocarcinoma of the esophagus, gastroesophageal junction, and stomach. The majority of previous studies in patients with these malignancies has examined age-based outcomes in surgical patients and in those receiving other forms of potentially curative therapy; but scant attention has been given to patients with metastatic disease (3-9). Focusing on this latter group is relevant because most patients diagnosed with these malignancies are found to have metastatic cancer either at diagnosis or at some point in their lives. In other cancer settings, elderly patients appear to derive comparable therapeutic outcomes from chemotherapy in exchange for higher rates of severe adverse events. In patients with lung cancer, breast cancer and other gastrointestinal cancers, elderly chemotherapy-treated patients suffer higher rates of severe myelosuppression, bleeding, nausea, and fatigue (10-12). Fewer such comparative studies have been conducted in patients with metastatic esophageal, gastroesophageal, and gastric cancer. Do such age-based differences in adverse events also occur in patients receiving first-line chemotherapy for these malignancies? The present study was undertaken to answer this question. Utilizing data from eight consecutive phase II trials, we sought to determine differences in adverse events and other outcomes in older and younger patients with metastatic esophageal, gastroesophageal, and gastric cancer. INTERNATIONAL JOURNAL OF ONCOLOGY 36: 601-606, 2010 Older versus younger patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction, and stomach: A pooled analysis of eight consecutive North Central Cancer Treatment Group (NCCTG) trials AMINAH JATOI1, NATHAN R. FOSTER1, JAMES R. EGNER2, PATRICK A. BURCH1, PHILIP J. STELLA3, JOSEPH RUBIN1, SHAKER R. DAKHIL4, DANIEL J. SARGENT1, BRIAN R. MURPHY5 and STEVEN R. ALBERTS1 1Mayo Clinic Rochester, Rochester, MN 55905; 2Carle Cancer Center CCOP, Urban, IL 61801; 3Michigan Cancer Research Consortium, Ann Arbor, MI 48106; 4Wichita Community Clinical Oncology Program, Wichita, KS 67214-3882; 5Toledo Community Hospital Oncology Program CCOP, Toledo, OH 43623, USA Received February 6, 2009; Accepted March 30, 2009 DOI: 10.3892/ijo_00000535 _________________________________________ Correspondence to: Dr Aminah Jatoi, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA E-mail: [email protected]