Total neoadjuvant therapy in early-onset versus average-onset locally advanced rectal cancer: patient characteristics and tolerance of therapy☆
Background: Patients with early-onset (EO, age <50 years) compared with average onset (AO, age ≥50 years) colorectal cancer have significantly higher rates of gastrointestinal toxicity with fluoropyrimidine and oxaliplatin therapy in the metastatic and adjuvant settings. Limited data exist regard...
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Elsevier
2025-06-01
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| Series: | ESMO Gastrointestinal Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949819825000391 |
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| author | M.L. Conces N. Tursun I. Ozgur S. Yilmaz D. Elamin S. Patil Y. Bouferraa E. Gorgun D. Liska E. Weinstein S.D. Kamath S.R. Steele A.A. Khorana B. Laderian T.T. Jayakrishnan K.G. Nair S.R. Amarnath E.H. Balagamwala B.N. Estfan H. Kessler M.J. McNamara M.A. Shapiro M.A. Valente S.S. Krishnamurthi |
| author_facet | M.L. Conces N. Tursun I. Ozgur S. Yilmaz D. Elamin S. Patil Y. Bouferraa E. Gorgun D. Liska E. Weinstein S.D. Kamath S.R. Steele A.A. Khorana B. Laderian T.T. Jayakrishnan K.G. Nair S.R. Amarnath E.H. Balagamwala B.N. Estfan H. Kessler M.J. McNamara M.A. Shapiro M.A. Valente S.S. Krishnamurthi |
| author_sort | M.L. Conces |
| collection | DOAJ |
| description | Background: Patients with early-onset (EO, age <50 years) compared with average onset (AO, age ≥50 years) colorectal cancer have significantly higher rates of gastrointestinal toxicity with fluoropyrimidine and oxaliplatin therapy in the metastatic and adjuvant settings. Limited data exist regarding tolerance of total neoadjuvant therapy (TNT) when treating younger patients with locally advanced rectal cancer (LARC) despite the rising incidence of EO rectal cancer. Materials and methods: Data were abstracted from a retrospective database of patients with LARC treated with TNT from 1 January 2015 through 28 April 2021. Characteristics compared between EO and AO patients were demographic features, baseline characteristics of tumor, treatment delivery, antiemetic use, and toxicities. Results: Of 115 patients (39 EO, 76 AO), female patients constituted 51% of EO patients and 34% of AO patients (P = 0.077). No differences were found in race, ethnicity, clinical stage, dose of radiation or chemotherapy received, and antiemetic premedications and prescriptions. EO patients (versus AO patients) had more nausea (59% versus 28%, P = 0.001), fatigue (72% versus 47%, P = 0.013), and proctitis (28% versus 13%, P = 0.048) during chemoradiation and more nausea (69% versus 42%, P = 0.006) and stomatitis (21% versus 3.9%, P = 0.007) during chemotherapy. After adjusting for sex, EO patients were still at a greater odds of nausea compared with AO during chemoradiation (odds ratio 3.45, 95% confidence interval 1.51-7.69, P = 0.004) and chemotherapy (odds ratio 2.85, 95% confidence interval 1.28-6.67, P = 0.012). Conclusions: Patients with EO, compared with AO, LARC receiving TNT appear to have higher rates of nausea and should be considered for enhanced antiemetic regimens. |
| format | Article |
| id | doaj-art-7fd889643f5e4bc3ac1ace05bb128a98 |
| institution | OA Journals |
| issn | 2949-8198 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | ESMO Gastrointestinal Oncology |
| spelling | doaj-art-7fd889643f5e4bc3ac1ace05bb128a982025-08-20T02:07:23ZengElsevierESMO Gastrointestinal Oncology2949-81982025-06-01810017010.1016/j.esmogo.2025.100170Total neoadjuvant therapy in early-onset versus average-onset locally advanced rectal cancer: patient characteristics and tolerance of therapy☆M.L. Conces0N. Tursun1I. Ozgur2S. Yilmaz3D. Elamin4S. Patil5Y. Bouferraa6E. Gorgun7D. Liska8E. Weinstein9S.D. Kamath10S.R. Steele11A.A. Khorana12B. Laderian13T.T. Jayakrishnan14K.G. Nair15S.R. Amarnath16E.H. Balagamwala17B.N. Estfan18H. Kessler19M.J. McNamara20M.A. Shapiro21M.A. Valente22S.S. Krishnamurthi23Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USADepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USADepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USADepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USADepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USADepartment of Quantitative Health Sciences, Cleveland Clinic, Cleveland, USADepartment of Internal Medicine, Cleveland Clinic, Cleveland, USADepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USA; Department of Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, USADepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USA; Department of Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, USADepartment of Palliative Medicine, Cleveland Clinic, Cleveland, USADepartment of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA; Department of Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, USADepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USA; Department of Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, USADepartment of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA; Department of Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, USADepartment of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USADepartment of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USADepartment of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA; Department of Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, USADepartment of Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, USA; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USADepartment of Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, USA; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USADepartment of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USADepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USA; Department of Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, USADepartment of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USADepartment of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USADepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USA; Department of Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, USADepartment of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA; Department of Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, USA; Correspondence to: Dr Smitha Krishnamurthi, MD, 9500 Euclid Ave, CA-5, Cleveland, OH 44195, USA. Tel: +1-216-444-8575Background: Patients with early-onset (EO, age <50 years) compared with average onset (AO, age ≥50 years) colorectal cancer have significantly higher rates of gastrointestinal toxicity with fluoropyrimidine and oxaliplatin therapy in the metastatic and adjuvant settings. Limited data exist regarding tolerance of total neoadjuvant therapy (TNT) when treating younger patients with locally advanced rectal cancer (LARC) despite the rising incidence of EO rectal cancer. Materials and methods: Data were abstracted from a retrospective database of patients with LARC treated with TNT from 1 January 2015 through 28 April 2021. Characteristics compared between EO and AO patients were demographic features, baseline characteristics of tumor, treatment delivery, antiemetic use, and toxicities. Results: Of 115 patients (39 EO, 76 AO), female patients constituted 51% of EO patients and 34% of AO patients (P = 0.077). No differences were found in race, ethnicity, clinical stage, dose of radiation or chemotherapy received, and antiemetic premedications and prescriptions. EO patients (versus AO patients) had more nausea (59% versus 28%, P = 0.001), fatigue (72% versus 47%, P = 0.013), and proctitis (28% versus 13%, P = 0.048) during chemoradiation and more nausea (69% versus 42%, P = 0.006) and stomatitis (21% versus 3.9%, P = 0.007) during chemotherapy. After adjusting for sex, EO patients were still at a greater odds of nausea compared with AO during chemoradiation (odds ratio 3.45, 95% confidence interval 1.51-7.69, P = 0.004) and chemotherapy (odds ratio 2.85, 95% confidence interval 1.28-6.67, P = 0.012). Conclusions: Patients with EO, compared with AO, LARC receiving TNT appear to have higher rates of nausea and should be considered for enhanced antiemetic regimens.http://www.sciencedirect.com/science/article/pii/S2949819825000391rectal cancerearly-onsetyoung-onsettotal neoadjuvant therapynauseasupportive care |
| spellingShingle | M.L. Conces N. Tursun I. Ozgur S. Yilmaz D. Elamin S. Patil Y. Bouferraa E. Gorgun D. Liska E. Weinstein S.D. Kamath S.R. Steele A.A. Khorana B. Laderian T.T. Jayakrishnan K.G. Nair S.R. Amarnath E.H. Balagamwala B.N. Estfan H. Kessler M.J. McNamara M.A. Shapiro M.A. Valente S.S. Krishnamurthi Total neoadjuvant therapy in early-onset versus average-onset locally advanced rectal cancer: patient characteristics and tolerance of therapy☆ ESMO Gastrointestinal Oncology rectal cancer early-onset young-onset total neoadjuvant therapy nausea supportive care |
| title | Total neoadjuvant therapy in early-onset versus average-onset locally advanced rectal cancer: patient characteristics and tolerance of therapy☆ |
| title_full | Total neoadjuvant therapy in early-onset versus average-onset locally advanced rectal cancer: patient characteristics and tolerance of therapy☆ |
| title_fullStr | Total neoadjuvant therapy in early-onset versus average-onset locally advanced rectal cancer: patient characteristics and tolerance of therapy☆ |
| title_full_unstemmed | Total neoadjuvant therapy in early-onset versus average-onset locally advanced rectal cancer: patient characteristics and tolerance of therapy☆ |
| title_short | Total neoadjuvant therapy in early-onset versus average-onset locally advanced rectal cancer: patient characteristics and tolerance of therapy☆ |
| title_sort | total neoadjuvant therapy in early onset versus average onset locally advanced rectal cancer patient characteristics and tolerance of therapy☆ |
| topic | rectal cancer early-onset young-onset total neoadjuvant therapy nausea supportive care |
| url | http://www.sciencedirect.com/science/article/pii/S2949819825000391 |
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