Young People with Advanced Colorectal Cancer Do As Well with Chemotherapy as Older Patients

Colondar Models

Colondar Models Erika and Cathy

When colorectal cancer spreads to other parts of the body, young people under 50 who get chemotherapy benefit as much as those who are older.

With drug combinations, there is no difference between those under 50 and those who are 50 and older in responding to chemotherapy, how long it takes before cancer gets worse, or in survival time.

Although colorectal cancer is primarily diagnosed in older people — the median age at diagnosis is 70 — about 10 percent of colon and rectal cancers are diagnosed under the age of 50.

While common wisdom was that younger patients had worse outcomes, a review of information from 9 randomized Phase III clinical trials testing first-line chemotherapy for metastatic colorectal cancer found this wasn’t true.

When a single drug was used, patients younger than 50 had shorter time before their cancer got worse (progression-free survival), but response to chemotherapy and overall survival time remained the same as patients who were fifty and older.

With combination treatments:

  • Median progression free survival was 7.2 months for patients under 50 and 8.4 months for those fifty and older.
  • Overall survival was 16.3 months for under 50 and 14.8 months for older patients.
  • 54 percent of younger patients had tumors shrink with chemotherapy compared to 51 percent of patients fifty and older.

None of these small differences were statistically significant.

Younger patients did have more severe nausea, with 10 percent experiencing grade 3 or worse nausea with chemo compared to 7 percent of older patients, but they had less severe diarrhea ( 11 percent versus 14 percent) and less incidence of low white cell counts (16 percent vs 23 percent).

Nearly 6,300 patients were included in the review with 793 under age 50 (13 percent) with 188 under 40 (3 percent).

Charles D. Blanke and his colleagues presented their study results in an abstract  during the 2010 meeting of the American Society of Clinical Oncology in Chicago.  They concluded,

Based on a comparison with SEER,  young advanced colorectal cancer patients are proportionally represented on phase III studies. Young age is modestly associated with poorer progression-free survival but not overall survival or response rate in treated advanced colorectal cancer patients, and young patients have more nausea but less diarrhea and neutropenis with chemotherapy in general. Young versus older patient derive the same benefits from combination chemotherapy.  Based on these data, in the absence of a clinical trial, standard combination chemotherapy approaches are appropriate for young advanced colorectal cancer patients.

SOURCEBlanke et al., 2010 ASCO Annual Meeting Abstracts, #3520.

Erika Kratzer and Cathy Aiken are the cover models for the 2010 Colondar, produced by the Colon Club. Erika is a ten year survivor of stage IV colon cancer, diagnosed when she was 22.  Cathy was 27 when she heard she was diagnosed in 1950 and this year celebrates 60 years of survival. You can get a copy of the Colondar and see all fourteen models, diagnosed under the age of 50, and read their stories.


  1. Kate Murphy says

    Yes. Overall survival time in this study is a median — half of patients died before the median overall survival time and half after.

    You may be interested in reading The Median Isn’t the Message” by Stephen Jay Gould.

    Dr. Gould’s essay is on the website of cancer patient advocate Steve Dunn.

  2. says

    Can you help me understand this statement:

    Overall survival was 16.3 months for under 50 and 14.8 months for older patients

    Does that refer to median overall survival?

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