Adjuvant Chemotherapy Significantly Improved Survival Benefit Among Elderly Patients With Stage 3 Colon Cancer
Key Clinical Takeaways
- Design/Population: In a real-world, population-based study, 41,630 patients with stage 3 colon cancer were analyzed by age (<75 vs ≥75 years) and receipt of adjuvant chemotherapy. End points included time from surgery to treatment, overall survival (OS), and recurrence-free survival (RFS).
- Key Outcomes: Adjuvant chemotherapy was given to 50.2% of patients overall, including 28.2% aged ≥75. Among older patients, 5-year OS was 62% with chemotherapy vs 41.8% without (HR 0.68; 95% CI, 0.65–0.71; P < .001). RFS was also improved (HR 0.71; 95% CI, 0.68–0.75; P < .001).
- Clinical Relevance: Despite underuse, elderly patients with stage 3 colon cancer derived significant survival benefit from adjuvant chemotherapy, supporting its consideration in patients ≥75 years when clinically appropriate.
According to results from a real-world, population-based study, adjuvant chemotherapy significantly improved survival benefit among patients ≥ 75 years of age with stage 3 colon cancer.
“In UICC stage III colon cancer, guidelines recommend adjuvant chemotherapy…however, specific recommendations for elderly patients remain inconsistent, partly due to their under-representation in randomized trials,” stated Melanie Langheinrich, MD, University Hospital Greifswald, Germany, and coauthors. “This results in a gap between trial populations and the broader patient population, making it difficult to draw conclusions about the benefits of chemotherapy for older patients in clinical routine.”
In this study, researchers collected data from 41,630 patients with stage 3 colon cancer treated at German clinical cancer centers between 2000 and 2020. Patients were split into cohorts based on age (either < 75 years or ≥ 75 years) and receipt of adjuvant chemotherapy. End points included mean time from surgery to chemotherapy initiation, overall survival (OS), and recurrence-free survival (RFS).
At analysis, 50.2% of patients received adjuvant chemotherapy including 28.2% of patients ≥ 75 years and 64% of patients < 75 years. The share of patients receiving oxaliplatin-based chemotherapy was 45.7% across the entire study period and the number of patients ≥ 75 years assigned oxaliplatin-based regimens increased from 11.6% to 22%. The mean time from surgery to chemotherapy initiation was consistent across all age groups at approximately 6 weeks. Among patients ≥ 75 years, the 5-year OS rate was 62% in patients treated with adjuvant chemotherapy and 41.8% in patients treated without adjuvant chemotherapy. There was a significant OS benefit (hazard ratio [HR] 0.677; 95% confidence interval [CI], 0.646 to 0.710; P < .001) and a significant RFS benefit (HR 0.714; 95% CI, 0.682 to 0.748; P < .001).
“This large population-based study reveals marked age-related disparities in the use of adjuvant chemotherapy in UICC stage 3 colon cancer,” concluded Dr Langheinrich et al. “Despite lower treatment rates, elderly patients derive substantial survival benefit, supporting careful consideration of adjuvant chemotherapy in patients aged 75 years and older.”
Source:
Langheinrich M, Gerken M, Robers G, et al. Survival benefit of adjuvant chemotherapy in elderly patients with UICC stage III colon carcinoma: A 20-year population-based German cohort study. Eur J Cancer. Published online: June 17, 2025. doi: 10.1016/j.ejca.2025.115583
