Practical Outcome of Adjuvant FOLFOX4 Chemotherapy in Elderly Patients with Stage III Colon Cancer: Single-center Study in Korea

Elderly patients derive similar benefits from 5-fluorouracil-based adjuvant chemotherapy in Stage III colon cancer; however, conflicting data exist regarding additional benefit from oxaliplatin, fluorouracil and leucovorin (FOLFOX) chemotherapy. Single-center, retrospective analysis was performed to compare the safety and efficacy of adjuvant oxaliplatin, fluorouracil and leucovorin-4 chemotherapy in older patients (age epsilon 65 years) with younger patients with Stage III colon cancer after surgical resection. Among 391 patients with Stage III colon cancer, 229 patients received adjuvant oxaliplatin, fluorouracil and leucovorin chemotherapy (87 (43.5) epsilon 65 years old versus 142 (74.3) 65 years old). Older patients had similar clinico-pathological characteristics as younger patients except for higher Charlson-Age comorbidity score (median 3.44 versus 2.85, P 0.01). The estimated 3-year disease-free survival (76.5 versus 80.0, P 0.88) and 3-year overall survival (90.9 versus 92.7, P 0.98) were similar. Grade 34 neutropenia was the only toxicity with higher frequency in the elderly patients (62.1 versus 46.5, P 0.02). Elderly patients received a lower relative dose intensity of oxaliplatin (0.76 versus 0.79) and 5-fluorouracil (0.75 versus 0.80, P 0.009). Adjuvant oxaliplatin, fluorouracil and leucovorin chemotherapy resulted in similar efficacy without significant increase in toxicity in older patients aged epsilon 65 when compared with younger patients with curatively resected Stage III colon cancer. Therefore, for colon cancer patients aged epsilon 65, oxaliplatin, fluorouracil and leucovorin chemotherapy can be recommended as safe and effective adjuvant chemotherapy after curative surgery in Asia.