Current Rectal Cancer Treatments Fall Short for Younger Patients With Advanced Disease

Current standard of care treatment for rectal cancer, which recommends combining surgery with chemotherapy and radiation, fails to prolong survival in patients younger than 50 years of age, according to findings published early online in the journal Cancer.

Rectal cancer has accounted for about 8% of new cancer cases and about 8% of overall cancer deaths, so far in 2018; the 5-year survival rate of the disease is 64.5%. Prognosis improves if the disease is diagnosed early—patients with stage I or localized disease have a better chance of longer survival compared with patients who have distant disease (stage II or higher).

“Our findings support the notion that rectal cancer in young patients may be biologically different from older patients, with differing response to treatment, as has been previously shown in colon cancer,” Atif Iqbal, MD, senior author on the study, said in a statement. “These findings may help stimulate future research trial proposals focused on the younger patient population.”

In terms of demographics, the disease is more common in men and patients of African American origin. Historically, studies have shown that the risk of incidence is highest for individuals in the 65-74 age group; older age has also been identified as a significant risk factor for death from colorectal cancer (CRC)—the highest death has been documented in the 75-84 age group.

However, a 2017 report by the American Cancer Society cites studies that have found an increase in the number of patients younger than 50 years old diagnosed with CRC, up from 6% in 1990 to 11% in 2013. Nearly three-fourths of the cases were in people in their 40s.¹

For the current analysis,² researchers from the University of Florida College of Medicine, Gainesville, Florida, examined 2004-2014 information on 52,519 patients from the National Cancer Database. Following analysis of data on 43,106 patients from the original cohort, the authors found that patients in this cohort under 50 years of age who had stage II or III rectal cancer did not see a survival advantage with the currently recommended National Comprehensive Cancer Network (NCCN) guidelines of chemotherapy, radiation, and surgery.

Overall, younger patients were primarily female and minorities, and were more likely to be at an advanced stage when diagnosed. Additionally, patients younger than 50 years had better short- and long-term outcomes and they had a higher probability of receiving radiation treatment outside of NCCN guidelines for stage I disease. However, for stage II and III patients under 50 years, neoadjuvant chemoradiation did not improve overall survival.

“These data suggest that early-onset disease may differ biologically and in its response to multimodality therapy,” the authors concluded.

References

1. American Cancer Society. Colorectal cancer: facts and figures, 2017-2019. American Cancer society website. cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf. Published 2017. Accessed July 10, 2018.
2. Kolarich A, George TJ Jr, Hughes SJ, et al. Rectal cancer patients younger than 50 years lack a survival benefit from NCCN guideline—directed treatment for stage II and III disease [published July 9, 2018]. Cancer. doi: 10.1002/cncr.31527.