Younger Patients with Metastatic Colorectal Cancer May Not Be Living Significantly Longer Than Older Patients

The incidence of young-onset colorectal cancer has been increasing in the past years, and despite being more physically active and receiving more intense treatments, younger patients are not living longer with the disease than older patients.

Patients younger than 50 with colorectal cancer had similar survival times compared with those older than 50 regardless of more favorable characteristics like physical activity and disease presentation.

Dr. Marla Lipsyc-Sharf, lead author on this study and clinical oncology fellow at the Dana-Farber Cancer Institute in Boston, explained in an interview with CURE® that it’s important to study this younger population, especially since colorectal cancer is expected to be the leading cause of cancer death in patients aged 20 to49 by 2040.

“It’s very important to understand survival in this population and whether this is clinically different from something we know quite well at this point, which is traditional-onset colorectal cancer, (which is) colorectal cancer diagnosed after age 50,” she added.

She and other researchers evaluated the overall survival (time at diagnosis or the start of treatment when a patient with the disease is still alive) and progression-free survival (time during and after treatment when the patient lives without disease progression) in 2,326 patients with metastatic colorectal cancer. Of these patients, 22.1% were younger than 50, with the remaining patients older than 50.

Median overall survival was 27.07 months for younger patients and 26.12 months for older patients, showing no statistically significant difference.

Additionally, there was no significant difference observed in median progression-free survival, with younger and older patients at 10.87 and 10.55 months, respectively.

Reasons for this, Lipsyc-Sharf explained, might be that younger patients are more likely to present with more advanced disease at diagnosis, therefore they might not have as long of survival time. “The earlier a cancer is diagnosed, the more curable a cancer is,” she said. “The fact that younger patients are being diagnosed with more-advanced stage disease tells us that the survival in this population overall may be worse than in the general population.”

Younger patients might be diagnosed at advanced stage due to screening age recommendations, she added. It was only recently the recommended age for colorectal cancer screening had changed from 50 years of age to 45.

“Now that younger patients will be included in this screening process, our hope is that more of these cancers will be able to be diagnosed at an earlier age, prevented and therefore contribute to an improvement in outcomes,” Lipsyc-Sharf added.

Although the results demonstrated no significant survival difference between patients, younger patients had favorable characteristics at the beginning of the study, which included that they were more physically active and received more intense chemotherapy. The reasoning for the similar survival times between the two groups is “particularly curious” to Lipsyc-Sharf and researchers, but it motivates them for future research.

“Many people in oncology and people outside of oncology thought that younger patients may have better survival because they are more fit and able to receive more treatments. And so yes, this is particularly surprising for that reason, and would be surprising likely to both providers in oncology and likely the general population,” she added.

Notably, patients who were younger than 35 years of age had a shorter overall survival at 21.95 months compared with 26.12 months in older patients, although this difference was not significant considering there were too few patients in this particular age group in this study.

“This is extremely important to think about moving forward because the incidence of colorectal cancer in this group is increasing very steeply,” Lipsyc-Sharf mentioned.

The only way to learn more and advanced about this topic is by studying patients with young onset colorectal cancer, she said.

“It’s important for patients that have been diagnosed with young-onset colorectal cancer to engage with their oncologists and engage with their medical teams about becoming involved in research to study this further,” Lipsyc-Sharf concluded. “The only way we will advance and learn more about this as a medical community is by studying patients with young-onset colorectal cancer.”


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