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Published in: BMC Cancer 1/2014

Open Access 01-12-2014 | Research article

Capecitabine in combination with oxaliplatin and bevacizumab (AXELOX) as 1st line treatment for fit and vulnerable elderly patients (aged >70 years) with metastatic colorectal cancer (mCRC): a multicenter phase II study of the Hellenic Oncology Research Group (HORG)

Authors: Lambros Vamvakas, Alexios Matikas, Athanasios Karampeazis, Dora Hatzidaki, Stelios Kakolyris, Charalampos Christophylakis, Ioannis Boukovinas, Aris Polyzos, Vassilis Georgoulias, John Souglakos

Published in: BMC Cancer | Issue 1/2014

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Abstract

Background

Colorectal cancer (CRC) is a disease of the elderly. However, geriatric patients are often excluded from clinical trials. The combination of capecitabine, oxaliplatin and bevacizumab (XELOX/BEV) has not been assessed in an elderly population.

Methods

We conducted a phase II study of XELOX plus bevacizumab combination as first line treatment in elderly patients with metastatic CRC. Treatment consisted of capecitabine 750 mg/m2 twice a day during days 1–7, oxaliplatin 85 mg/m2 and bevacizumab 5 mg/kg on day 1. Treatment was repeated every 14 days. The primary endpoint was overall response rate.

Results

In the 48 enrolled patients response rate according was 46.8% (95% CI: 32.54%–61.07%), while 13 patients had stable disease, for an overall disease control rate of 74.4% (95% CI: 57.8–91.2). Progression free survival was 7.9 months (95% CI: 5.9–9.8 months) and the median overall survival 20.1 months (95% CI: 15.6–25.7 months). Response rate and progression free survival has been correlated with baseline albumin and haemoglobin levels. There was one treatment-related death. Grade 3–4 toxicities were asthenia (4.2%), neurotoxicity (2.1%) and diarrhea 6.3%).

Conclusions

The combination of capecitabine, oxaliplatin and bevacizumab is an effective and safe combination for the treatment of elderly patients with metastatic CRC.

Trial registration

Clinical trials NCT01024504, 26 November 2010.
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Literature
1.
go back to reference Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ: Cancer statistics, 2008. CA Cancer J Clin. 2008, 58 (2): 71-96. 10.3322/CA.2007.0010.CrossRefPubMed Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ: Cancer statistics, 2008. CA Cancer J Clin. 2008, 58 (2): 71-96. 10.3322/CA.2007.0010.CrossRefPubMed
2.
go back to reference Edwards BK, Brown ML, Wingo PA, Howe HL, Ward E, Ries LA, Schrag D, Jamison PM, Jemal A, Wu XC, Friedman C, Harlan L, Warren J, Anderson RN, Pickle LW: Annual report to the nation on the status of cancer, 1975-2002, featuring population-based trends in cancer treatment. J Natl Cancer Inst. 2005, 97 (19): 1407-1427. 10.1093/jnci/dji289.CrossRefPubMed Edwards BK, Brown ML, Wingo PA, Howe HL, Ward E, Ries LA, Schrag D, Jamison PM, Jemal A, Wu XC, Friedman C, Harlan L, Warren J, Anderson RN, Pickle LW: Annual report to the nation on the status of cancer, 1975-2002, featuring population-based trends in cancer treatment. J Natl Cancer Inst. 2005, 97 (19): 1407-1427. 10.1093/jnci/dji289.CrossRefPubMed
3.
go back to reference Sawhney R, Sehl M, Naeim A: Physiologic aspects of aging: impact on cancer management and decision making, part I. Cancer J. 2005, 11 (6): 449-460. 10.1097/00130404-200511000-00004.CrossRefPubMed Sawhney R, Sehl M, Naeim A: Physiologic aspects of aging: impact on cancer management and decision making, part I. Cancer J. 2005, 11 (6): 449-460. 10.1097/00130404-200511000-00004.CrossRefPubMed
4.
go back to reference Sehl M, Sawhney R, Naeim A: Physiologic aspects of aging: impact on cancer management and decision making, part II. Cancer J. 2005, 11 (6): 461-473. 10.1097/00130404-200511000-00005.CrossRefPubMed Sehl M, Sawhney R, Naeim A: Physiologic aspects of aging: impact on cancer management and decision making, part II. Cancer J. 2005, 11 (6): 461-473. 10.1097/00130404-200511000-00005.CrossRefPubMed
5.
go back to reference Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Bhatia S, Katheria V, Klapper S, Hansen K, Ramani R, Lachs M, Wong FL, Tew WP: Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011, 29 (25): 3457-3465. 10.1200/JCO.2011.34.7625.CrossRefPubMedPubMedCentral Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Bhatia S, Katheria V, Klapper S, Hansen K, Ramani R, Lachs M, Wong FL, Tew WP: Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011, 29 (25): 3457-3465. 10.1200/JCO.2011.34.7625.CrossRefPubMedPubMedCentral
6.
go back to reference Soubeyran P, Fonck M, Blanc-Bisson C, Blanc JF, Ceccaldi J, Mertens C, Imbert Y, Cany L, Vogt L, Dauba J, Andriamampionona F, Houédé N, Floquet A, Chomy F, Brouste V, Ravaud A, Bellera C, Rainfray M: Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol. 2012, 30 (15): 1829-1834. 10.1200/JCO.2011.35.7442.CrossRefPubMed Soubeyran P, Fonck M, Blanc-Bisson C, Blanc JF, Ceccaldi J, Mertens C, Imbert Y, Cany L, Vogt L, Dauba J, Andriamampionona F, Houédé N, Floquet A, Chomy F, Brouste V, Ravaud A, Bellera C, Rainfray M: Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol. 2012, 30 (15): 1829-1834. 10.1200/JCO.2011.35.7442.CrossRefPubMed
7.
go back to reference Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ: Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993, 342 (8878): 1032-1036. 10.1016/0140-6736(93)92884-V.CrossRefPubMed Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ: Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993, 342 (8878): 1032-1036. 10.1016/0140-6736(93)92884-V.CrossRefPubMed
8.
go back to reference Goldberg RM, Tabah-Fisch I, Bleiberg H, de Gramont A, Tournigand C, Andre T, Rothenberg ML, Green E, Sargent DJ: Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly in elderly patients with colorectal cancer. J Clin Oncol. 2006, 24 (25): 4085-4091. 10.1200/JCO.2006.06.9039.CrossRefPubMed Goldberg RM, Tabah-Fisch I, Bleiberg H, de Gramont A, Tournigand C, Andre T, Rothenberg ML, Green E, Sargent DJ: Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly in elderly patients with colorectal cancer. J Clin Oncol. 2006, 24 (25): 4085-4091. 10.1200/JCO.2006.06.9039.CrossRefPubMed
9.
go back to reference Mattioli R, Massacesi C, Recchia F, Marcucci F, Cappelletti C, Imperatori L, Pilone A, Rocchi M, Cesta A, Laici G, Bonsignori M, Lippe P: High activity and reduced neurotoxicity of bi-fractionated oxaliplatin plus 5-fluorouracil/leucovorin for elderly patients with advanced colorectal cancer. Ann Oncol. 2005, 16 (7): 1147-1151. 10.1093/annonc/mdi222.CrossRefPubMed Mattioli R, Massacesi C, Recchia F, Marcucci F, Cappelletti C, Imperatori L, Pilone A, Rocchi M, Cesta A, Laici G, Bonsignori M, Lippe P: High activity and reduced neurotoxicity of bi-fractionated oxaliplatin plus 5-fluorouracil/leucovorin for elderly patients with advanced colorectal cancer. Ann Oncol. 2005, 16 (7): 1147-1151. 10.1093/annonc/mdi222.CrossRefPubMed
10.
go back to reference Sastre J, Aranda E, Massuti B, Tabernero J, Chaves M, Abad A, Carrato A, Reina JJ, Queralt B, Gomez-Espana A, Gonzalez-Flores E, Rivera F, Losa F, Garcia T, Sanchez-Rovira P, Maestu I, Diaz-Rubio E: Elderly patients with advanced colorectal cancer derive similar benefit without excessive toxicity after first-line chemotherapy with oxaliplatin-based combinations: comparative outcomes from the 03-TTD-01 phase III study. Crit Rev Oncol Hematol. 2009, 70 (2): 134-144. 10.1016/j.critrevonc.2008.11.002.CrossRefPubMed Sastre J, Aranda E, Massuti B, Tabernero J, Chaves M, Abad A, Carrato A, Reina JJ, Queralt B, Gomez-Espana A, Gonzalez-Flores E, Rivera F, Losa F, Garcia T, Sanchez-Rovira P, Maestu I, Diaz-Rubio E: Elderly patients with advanced colorectal cancer derive similar benefit without excessive toxicity after first-line chemotherapy with oxaliplatin-based combinations: comparative outcomes from the 03-TTD-01 phase III study. Crit Rev Oncol Hematol. 2009, 70 (2): 134-144. 10.1016/j.critrevonc.2008.11.002.CrossRefPubMed
11.
go back to reference Seymour MT, Thompson LC, Wasan HS, Middleton G, Brewster AE, Shepherd SF, O’Mahony MS, Maughan TS, Parmar M, Langley RE: Chemotherapy options in elderly and frail patients with metastatic colorectal cancer (MRC FOCUS2): an open-label, randomised factorial trial. Lancet. 2011, 377 (9779): 1749-1759. 10.1016/S0140-6736(11)60399-1.CrossRefPubMedPubMedCentral Seymour MT, Thompson LC, Wasan HS, Middleton G, Brewster AE, Shepherd SF, O’Mahony MS, Maughan TS, Parmar M, Langley RE: Chemotherapy options in elderly and frail patients with metastatic colorectal cancer (MRC FOCUS2): an open-label, randomised factorial trial. Lancet. 2011, 377 (9779): 1749-1759. 10.1016/S0140-6736(11)60399-1.CrossRefPubMedPubMedCentral
12.
go back to reference Van Cutsem E, Rivera F, Berry S, Kretzschmar A, Michael M, DiBartolomeo M, Mazier MA, Canon JL, Georgoulias V, Peeters M, Bridgewater J, Cunningham D, First BEAT investigators: Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study. Ann Oncol. 2009, 20 (11): 1842-1847. 10.1093/annonc/mdp233.CrossRefPubMed Van Cutsem E, Rivera F, Berry S, Kretzschmar A, Michael M, DiBartolomeo M, Mazier MA, Canon JL, Georgoulias V, Peeters M, Bridgewater J, Cunningham D, First BEAT investigators: Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study. Ann Oncol. 2009, 20 (11): 1842-1847. 10.1093/annonc/mdp233.CrossRefPubMed
13.
go back to reference Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, Nordlinger B, van de Velde CJ, Balmana J, Regula J, Nagtegaal ID, Beets-Tan RG, Arnold D, Ciardiello F, Hoff P, Kerr D, Köhne CH, Labianca R, Price T, Scheithauer W, Sobrero A, Tabernero J, Aderka D, Barroso S, Bodoky G, Douillard JY, El Ghazaly H, Gallardo J, Garin A, Glynne-Jones R, et al: ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann Oncol. 2012, 23 (10): 2479-2516. 10.1093/annonc/mds236.CrossRefPubMed Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, Nordlinger B, van de Velde CJ, Balmana J, Regula J, Nagtegaal ID, Beets-Tan RG, Arnold D, Ciardiello F, Hoff P, Kerr D, Köhne CH, Labianca R, Price T, Scheithauer W, Sobrero A, Tabernero J, Aderka D, Barroso S, Bodoky G, Douillard JY, El Ghazaly H, Gallardo J, Garin A, Glynne-Jones R, et al: ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann Oncol. 2012, 23 (10): 2479-2516. 10.1093/annonc/mds236.CrossRefPubMed
14.
go back to reference Tsai HT, Marshall JL, Weiss SR, Huang CY, Warren JL, Freedman AN, Fu AZ, Sansbury LB, Potosky AL: Bevacizumab use and risk of cardiovascular adverse events among elderly patients with colorectal cancer receiving chemotherapy: a population-based study. Ann Oncol. 2013, 24 (6): 1574-1579. 10.1093/annonc/mdt019.CrossRefPubMedPubMedCentral Tsai HT, Marshall JL, Weiss SR, Huang CY, Warren JL, Freedman AN, Fu AZ, Sansbury LB, Potosky AL: Bevacizumab use and risk of cardiovascular adverse events among elderly patients with colorectal cancer receiving chemotherapy: a population-based study. Ann Oncol. 2013, 24 (6): 1574-1579. 10.1093/annonc/mdt019.CrossRefPubMedPubMedCentral
15.
go back to reference Cunningham D, Lang I, Marcuello E, Lorusso V, Ocvirk J, Shin DB, Jonker D, Osborne S, Andre N, Waterkamp D, Saunders MP, AVEX study investigators: Bevacizumab plus capecitabine versus capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer (AVEX): an open-label, randomised phase 3 trial. Lancet Oncol. 2013, 14 (11): 1077-1085. 10.1016/S1470-2045(13)70154-2.CrossRefPubMed Cunningham D, Lang I, Marcuello E, Lorusso V, Ocvirk J, Shin DB, Jonker D, Osborne S, Andre N, Waterkamp D, Saunders MP, AVEX study investigators: Bevacizumab plus capecitabine versus capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer (AVEX): an open-label, randomised phase 3 trial. Lancet Oncol. 2013, 14 (11): 1077-1085. 10.1016/S1470-2045(13)70154-2.CrossRefPubMed
16.
go back to reference Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000, 92 (3): 205-216. 10.1093/jnci/92.3.205.CrossRefPubMed Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000, 92 (3): 205-216. 10.1093/jnci/92.3.205.CrossRefPubMed
17.
go back to reference Basso U, Monfardini S: Multidimensional geriatric evaluation in elderly cancer patients: a practical approach. Eur J Cancer Care (Engl). 2004, 13 (5): 424-433. 10.1111/j.1365-2354.2004.00551.x.CrossRef Basso U, Monfardini S: Multidimensional geriatric evaluation in elderly cancer patients: a practical approach. Eur J Cancer Care (Engl). 2004, 13 (5): 424-433. 10.1111/j.1365-2354.2004.00551.x.CrossRef
18.
go back to reference Kakolyris S, Souglakos J, Polyzos A, Ardavanis A, Ziras N, Athanasiadis A, Varthalitis I, Amarantidis K, Tsousis S, Vamvakas L, Vardakis N, Georgoulias V, Hellenic Oncology Research Group: Modified CAPOX (capecitabine plus oxaliplatin) regimen every two weeks as second-line treatment in patients with advanced colorectal cancer previously treated with irinotecan-based frontline therapy: a multicenter phase II study. Oncology. 2008, 74 (1–2): 31-36.CrossRefPubMed Kakolyris S, Souglakos J, Polyzos A, Ardavanis A, Ziras N, Athanasiadis A, Varthalitis I, Amarantidis K, Tsousis S, Vamvakas L, Vardakis N, Georgoulias V, Hellenic Oncology Research Group: Modified CAPOX (capecitabine plus oxaliplatin) regimen every two weeks as second-line treatment in patients with advanced colorectal cancer previously treated with irinotecan-based frontline therapy: a multicenter phase II study. Oncology. 2008, 74 (1–2): 31-36.CrossRefPubMed
19.
go back to reference Aparicio T, Jouve JL, Teillet L, Gargot D, Subtil F, Le Brun-Ly V, Cretin J, Locher C, Bouche O, Breysacher G, Charneau J, Seitz JF, Gasmi M, Stefani L, Ramdani M, Lecomte T, Mitry E: Geriatric factors predict chemotherapy feasibility: ancillary results of FFCD 2001-02 phase III study in first-line chemotherapy for metastatic colorectal cancer in elderly patients. J Clin Oncol. 2013, 31 (11): 1464-1470. 10.1200/JCO.2012.42.9894.CrossRefPubMed Aparicio T, Jouve JL, Teillet L, Gargot D, Subtil F, Le Brun-Ly V, Cretin J, Locher C, Bouche O, Breysacher G, Charneau J, Seitz JF, Gasmi M, Stefani L, Ramdani M, Lecomte T, Mitry E: Geriatric factors predict chemotherapy feasibility: ancillary results of FFCD 2001-02 phase III study in first-line chemotherapy for metastatic colorectal cancer in elderly patients. J Clin Oncol. 2013, 31 (11): 1464-1470. 10.1200/JCO.2012.42.9894.CrossRefPubMed
20.
go back to reference Kozloff MF, Berlin J, Flynn PJ, Kabbinavar F, Ashby M, Dong W, Sing AP, Grothey A: Clinical outcomes in elderly patients with metastatic colorectal cancer receiving bevacizumab and chemotherapy: results from the BRiTE observational cohort study. Oncology. 2010, 78 (5–6): 329-339.CrossRefPubMed Kozloff MF, Berlin J, Flynn PJ, Kabbinavar F, Ashby M, Dong W, Sing AP, Grothey A: Clinical outcomes in elderly patients with metastatic colorectal cancer receiving bevacizumab and chemotherapy: results from the BRiTE observational cohort study. Oncology. 2010, 78 (5–6): 329-339.CrossRefPubMed
21.
go back to reference Kabbinavar FF, Hurwitz HI, Yi J, Sarkar S, Rosen O: Addition of bevacizumab to fluorouracil-based first-line treatment of metastatic colorectal cancer: pooled analysis of cohorts of older patients from two randomized clinical trials. J Clin Oncol. 2009, 27 (2): 199-205. 10.1200/JCO.2008.17.7931.CrossRefPubMed Kabbinavar FF, Hurwitz HI, Yi J, Sarkar S, Rosen O: Addition of bevacizumab to fluorouracil-based first-line treatment of metastatic colorectal cancer: pooled analysis of cohorts of older patients from two randomized clinical trials. J Clin Oncol. 2009, 27 (2): 199-205. 10.1200/JCO.2008.17.7931.CrossRefPubMed
22.
go back to reference Price TJ, Zannino D, Wilson K, Simes RJ, Cassidy J, Van Hazel GA, Robinson BA, Broad A, Ganju V, Ackland SP, Tebbutt NC: Bevacizumab is equally effective and no more toxic in elderly patients with advanced colorectal cancer: a subgroup analysis from the AGITG MAX trial: an international randomised controlled trial of Capecitabine, Bevacizumab and Mitomycin C. Ann Oncol. 2012, 23 (6): 1531-1536. 10.1093/annonc/mdr488.CrossRefPubMed Price TJ, Zannino D, Wilson K, Simes RJ, Cassidy J, Van Hazel GA, Robinson BA, Broad A, Ganju V, Ackland SP, Tebbutt NC: Bevacizumab is equally effective and no more toxic in elderly patients with advanced colorectal cancer: a subgroup analysis from the AGITG MAX trial: an international randomised controlled trial of Capecitabine, Bevacizumab and Mitomycin C. Ann Oncol. 2012, 23 (6): 1531-1536. 10.1093/annonc/mdr488.CrossRefPubMed
23.
go back to reference Venderbosch S, Doornebal J, Teerenstra S, Lemmens W, Punt CJ, Koopman M: Outcome of first line systemic treatment in elderly compared to younger patients with metastatic colorectal cancer: a retrospective analysis of the CAIRO and CAIRO2 studies of the Dutch Colorectal Cancer Group (DCCG). Acta Oncol. 2012, 51 (7): 831-839. 10.3109/0284186X.2012.699193.CrossRefPubMed Venderbosch S, Doornebal J, Teerenstra S, Lemmens W, Punt CJ, Koopman M: Outcome of first line systemic treatment in elderly compared to younger patients with metastatic colorectal cancer: a retrospective analysis of the CAIRO and CAIRO2 studies of the Dutch Colorectal Cancer Group (DCCG). Acta Oncol. 2012, 51 (7): 831-839. 10.3109/0284186X.2012.699193.CrossRefPubMed
Metadata
Title
Capecitabine in combination with oxaliplatin and bevacizumab (AXELOX) as 1st line treatment for fit and vulnerable elderly patients (aged >70 years) with metastatic colorectal cancer (mCRC): a multicenter phase II study of the Hellenic Oncology Research Group (HORG)
Authors
Lambros Vamvakas
Alexios Matikas
Athanasios Karampeazis
Dora Hatzidaki
Stelios Kakolyris
Charalampos Christophylakis
Ioannis Boukovinas
Aris Polyzos
Vassilis Georgoulias
John Souglakos
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2014
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-14-277

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