Colon cancer represents one of the most common cancers diagnosed in older adults worldwide.The standard of care in resected stage II and stage III colon cancer continues to evolve.While there is unequivocal evidence t...Colon cancer represents one of the most common cancers diagnosed in older adults worldwide.The standard of care in resected stage II and stage III colon cancer continues to evolve.While there is unequivocal evidence to suggest both disease free and overall survival benefits with the use of combination chemotherapy in patients with stage III colon cancer,data regarding its use in patients with stage II colon cancer are less clear.Further,although colon cancer is a disease that affects older adults,there is considerable debate on the value of adjuvant chemotherapy in the aging population.In particular,many older patients are undertreated when compared to their younger counterparts.In this review,we will describe the clinical trials that contributed to the current adjuvant chemotherapy approach in colon cancer,discuss representation of older adults in trials and the specific challenges associated with the management of this subpopulation,and highlight the role of comprehensive geriatric assessments.We will also review how real-world evidence complements the data gaps from clinical trials of early stage colon cancer.展开更多
In spite of recent diagnostic and therapeutic advances,the prognosis of pancreatic ductal adenocarcinoma(PDAC)remains very poor.As most patients are not amenable to curative intent treatments,optimized palliative mana...In spite of recent diagnostic and therapeutic advances,the prognosis of pancreatic ductal adenocarcinoma(PDAC)remains very poor.As most patients are not amenable to curative intent treatments,optimized palliative management is highly needed.One key question is to what extent promising results produced by randomized controlled trials(RCTs)correspond to clinically meaningful outcomes in patients treated outside the strict frames of a clinical trial.To answer such questions,real-world evidence is necessary.The present paper reviews and discusses the current literature on first-and second-line palliative chemotherapy in PDAC.Notably,a growing number of studies report that the outcomes of the two predominant first-line multidrug regimens,i.e.gemcitabine plus nabpaclitaxel(GnP)and folfirinox(FFX),is similar in RCTs and real-life populations.Outcomes of second-line therapy following failure of first-line regimens are still dismal,and considerable uncertainty of the optimal management remains.Additional RCTs and real-world evidence studies focusing on the optimal treatment sequence,such as FFX followed by GnP or vice versa,are urgently needed.Finally,the review highlights the need for prognostic and predictive biomarkers to inform clinical decision making and enable personalized management in advanced PDAC.展开更多
文摘Colon cancer represents one of the most common cancers diagnosed in older adults worldwide.The standard of care in resected stage II and stage III colon cancer continues to evolve.While there is unequivocal evidence to suggest both disease free and overall survival benefits with the use of combination chemotherapy in patients with stage III colon cancer,data regarding its use in patients with stage II colon cancer are less clear.Further,although colon cancer is a disease that affects older adults,there is considerable debate on the value of adjuvant chemotherapy in the aging population.In particular,many older patients are undertreated when compared to their younger counterparts.In this review,we will describe the clinical trials that contributed to the current adjuvant chemotherapy approach in colon cancer,discuss representation of older adults in trials and the specific challenges associated with the management of this subpopulation,and highlight the role of comprehensive geriatric assessments.We will also review how real-world evidence complements the data gaps from clinical trials of early stage colon cancer.
文摘In spite of recent diagnostic and therapeutic advances,the prognosis of pancreatic ductal adenocarcinoma(PDAC)remains very poor.As most patients are not amenable to curative intent treatments,optimized palliative management is highly needed.One key question is to what extent promising results produced by randomized controlled trials(RCTs)correspond to clinically meaningful outcomes in patients treated outside the strict frames of a clinical trial.To answer such questions,real-world evidence is necessary.The present paper reviews and discusses the current literature on first-and second-line palliative chemotherapy in PDAC.Notably,a growing number of studies report that the outcomes of the two predominant first-line multidrug regimens,i.e.gemcitabine plus nabpaclitaxel(GnP)and folfirinox(FFX),is similar in RCTs and real-life populations.Outcomes of second-line therapy following failure of first-line regimens are still dismal,and considerable uncertainty of the optimal management remains.Additional RCTs and real-world evidence studies focusing on the optimal treatment sequence,such as FFX followed by GnP or vice versa,are urgently needed.Finally,the review highlights the need for prognostic and predictive biomarkers to inform clinical decision making and enable personalized management in advanced PDAC.
