75 yo w/ MSS T3 (1/20 node pos) tumor: Would you offer Oncotype DX® assay? If not, what Tx recommend?
Would you offer an Oncotype DX assay for an otherwise healthy 75-year-old patient with a Grade II, MSS T3 (1 out of 20 nodes positive) tumor?
If not, what adjuvant systemic therapy would you likely recommend for this patient?
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Steven R Alberts, MD, MPH |
| Chair, Division of Medical Oncology Professor of Oncology Mayo Clinic Rochester, Minnesota |
For a robust 75-year-old patient I would order an Oncotype DX assay.
For a 75-year-old patient with Grade II, MSS T3 disease with 1 out of 20 positive nodes, I would recommend treatment with capecitabine or 5-FU/leucovorin.
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Al B Benson III, MD |
| Professor of Medicine Associate Director for Clinical Investigations Robert H Lurie Comprehensive Cancer Center of Northwestern University Chicago, Illinois |
I would not order an Oncotype DX assay for this patient unless the patient were thinking that he or she wanted chemotherapy and would like to have more information on risk in order to make the decision whether to rule out chemotherapy as a treatment option (ie, if the Recurrence Score indicated low risk).
For this 75-year-old patient I would recommend treatment with an oxaliplatin-based regimen. I would talk to the patient about the controversies associated with the additional benefits of an oxaliplatin regimen.
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Charles S Fuchs, MD, MPH |
| Director Center for Gastrointestinal Cancer Dana-Farber/Harvard Cancer Center Professor of Medicine Harvard Medical School Boston, Massachusetts |
I would not order an Oncotype DX assay for this patient because the results would not affect my treatment decision.
For this older patient with Grade II, MSS disease that is node positive, I would recommend treatment with FOLFOX considering that the patient is otherwise healthy.
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Richard M Goldberg, MD |
| Professor of Medicine Physician-in-Chief, OSUCCC - James Cancer Hospital and Richard J Solove Research Institute Klotz Family Chair in Cancer Research The Ohio State University Columbus, Ohio |
I would order an Oncotype DX assay after a discussion with the patient, but I would not order it routinely.
I’d probably recommend 5-FU alone for this 75-year-old patient with 1 out of 20 positive nodes. Selectively, for patients over the age of 65 I offer FOLFOX rather than 5-FU, but the most recent data suggest that adding oxaliplatin to 5-FU may not provide a benefit to older patients.
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Axel Grothey, MD |
| Professor of Oncology Department of Medical Oncology Mayo Clinic Rochester, Minnesota |
No, I would not order an Oncotype DX assay for this 75-year-old patient.
For Stage III disease the default is to use oxaliplatin-based therapy. The caveat is that we don’t have good data on whether patients older than 75 benefit from the addition of oxaliplatin to a fluoropyrimidine. For this older patient with 1 positive node I would recommend treatment with capecitabine alone.
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Howard S Hochster, MD |
| Associate Director (Clinical Research) Yale Cancer Center Professor of Medicine Yale School of Medicine New Haven, Connecticut |
Yes, I would order an Oncotype DX assay in this clinical scenario.
I would probably recommend treatment with FOLFOX for a 75-year-old patient with Grade II, MSS T3 disease with 1 out of 20 positive nodes. I don’t believe that oxaliplatin adds much more toxicity to the regimen. Also, some data suggest that elderly patients tolerate oxaliplatin as well as younger patients.
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Herbert I Hurwitz, MD |
| Associate Professor of Medicine Division of Hematology/Oncology Clinical Director, Phase I Program Co-leader, GI Oncology Program Duke University Medical Center Durham, North Carolina |
I would most likely order an Oncotype DX assay for such a patient. If the patient was not fit, however, and capecitabine or 5-FU was not in the cards, then I would not order the assay. Given an extremely fit 75-year-old patient, I might also discuss the pros and cons of trying to manage the patient’s disease as I would for a 65-year-old.
I would probably administer 5-FU alone to the majority of patients in this setting. I would recommend treatment with an oxaliplatin-based regimen for the subset of patients in this setting with the best performance status or for those at higher risk. The lower the risk or performance status, the more the issue becomes whether to use either a fluoropyrimidine or nothing.
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Wells A Messersmith, MD |
| Professor and Director GI Medical Oncology Program Co-Leader Developmental Therapeutics Program University of Colorado Cancer Center Aurora, Colorado |
No, I would not order an Oncotype DX assay for this patient.
I would administer adjuvant FOLFOX to this 75-year-old patient with Grade II node-positive disease.