Assessment of Oral Capecitabine in Elderly Patients with Stage 2 Colon Cancer: Toxicity, Tolerability, and Survival Outcomes

Abstract

Introduction: Adjuvant chemotherapy, particularly oral capecitabine, is often considered for stage 2 colon cancer despite its controversial use in elderly patients with comorbidities. This study aimed to assess the toxicity, tolerability, and survival outcomes of oral capecitabine in elderly patients diagnosed with T4N0, stage 2 colon cancer. Methods: This retrospective study included 52 patients aged >70 years who were diagnosed with T4N0M0 colon cancer and received adjuvant capecitabine. Treatment toxicities were graded according to the National Cancer Institute of Canada Common Toxicity Criteria v4. Overall survival (OS) was analyzed. Results: The study revealed that 86% of patients experienced treatment-related adverse events, with 29% exhibiting grade 3 and 23% grade 4 toxicities. Common severe adverse events include diarrhea and nausea. Despite starting treatment at lower doses, a significant proportion of patients required further dose reductions due to side effects, with only seven patients completing the full eight cycles of capecitabine. The median follow-up was 48 months, with disease-free survival and relapse-free survival rates of 61.6% and 67%, respectively. The 5-year OS rate was 71%. Conclusion: In stage 2 colon cancer, administering adjuvant capecitabine to elderly patients aged >70 years poses challenges due to significant toxicity and tolerability issues. However, our study found that even with dose reductions, adjuvant therapy remains crucial for elderly patients, with a 71% 5-year OS rate similar to that of younger populations.

Keywords

• colon neoplasms
• chemotherapy
• adjuvant
• aged
• capecitabine