Young Stage IV Colorectal Cancer Patients More Likely to Receive and Benefit from Aggressive Treatments, Study Finds

New research has found that patients with stage IV early-onset colorectal cancer — defined as individuals under the age of 50 — are more likely to receive chemotherapy and surgery compared to older patients. Additionally, this data, which was recently presented during the Digestive Disease Week Conference, found that younger patients who were treated with surgery also had better overall and cancer-specific survival.

“The incidence of colorectal cancer in young people — those under the age of 50 — has been increasing at an alarming rate recently,” says study senior author David Liska, MD, Chair of the Department of Colorectal Surgery, Cleveland Clinic. “Colorectal cancer is the number one cause of cancer deaths in men under the age of 50, and the number two most common cause of cancer deaths in women under the age of 50.

“Additionally, patients with early-onset colorectal cancer are more likely to present with advanced or metastatic disease compared to individuals who are diagnosed later in life,” he continues. “While younger patients are often able to tolerate more aggressive treatment regimens, including chemotherapy and surgery, whether or not these treatment strategies lead to improved outcomes remains controversial.”

Research highlights

Dr. Liska and colleagues hypothesized that among patients with stage IV disease, early-onset colorectal cancer (EOCRC) patients were more likely to receive chemotherapy and surgery and had better survival outcomes when compared to average-onset colorectal cancer (AOCRC) patients.

Researchers conducted a retrospective review of adult patients who were diagnosed with stage IV colorectal adenocarcinoma and seen at Cleveland Clinic between 2010-2020. This analysis excluded patients with a hereditary colorectal cancer syndrome or inflammatory bowel disease.

Patients aged 18 to 49 and those 50 or older were categorized as early-onset colorectal cancer and average-onset colorectal cancer, respectively. The study included 959 — 777 AOCRC and 182 EOCRC — patients. The mean age at diagnosis in the AOCRC cohort was 67.1 years compared with 43.1 years in the EOCRC group.

Data showed that rectal cancer was more frequent among patients with early-onset disease (25.3% vs. 17.1%; P = .037). Additionally, the younger patient cohort were more likely to receive chemotherapy (91.8% vs. 75.3%; P < .001) and surgery (76.4% vs. 63.1%; P < .001) compared to their AOCRC counterparts.

Dr. Liska and his team found that early-onset colorectal cancer is associated with better overall and cancer-specific survival. They observed no difference in survival between AOCRC and EOCRC patients who did not undergo surgery. However, when looking at AOCRC to EOCRC patients who received surgery, survival was longer among younger patients.

Summarizing their findings, Dr. Liska notes, “This study demonstrated that patients with stage IV early-onset colorectal cancer who received treatment at a tertiary referral center were more likely to receive chemotherapy and surgery than older patients and have better overall and cancer-specific survival.

“The best outcomes were observed among EOCRC patients who underwent surgical treatment,” he adds while emphasizing the need for further study to identify the optimal selection criteria for surgery in metastatic EOCRC.

Implications and next steps

This study confirms that, in aggregate, their institution’s approach being taken for many patients with early-onset colorectal cancer is the right one, according to Dr. Liska. “If you select patients judiciously for aggressive treatment with surgery to remove both the primary tumor and metastases, it will often result in better outcomes,” he says. “However, this research also emphasizes the need to study which patients would benefit most from this course of treatment.”

Moving forward, Dr. Liska emphasized the importance of understanding how to improve patient selection. “Determining when to use more aggressive intervention is not always easy,” he notes. “Where is the threshold between providing a benefit and putting a patient through additional treatments that aren’t making a significant difference or potentially even harm the patient? That’s what we still need to figure out. Further study will help us make the best decisions to ensure not only optimal patient outcomes but also improved quality of life.”

It is also critical, Dr. Liska notes, to take a multidisciplinary approach to the care of these patients. “Here at Cleveland Clinic, we have the DeBArtolo Center for Young-Onset Colorectal Cancer that is dedicated to the unique needs and care of young people with colorectal cancer. A multidisciplinary team of experts providing comprehensive and coordinated care is vital for success, especially when employing aggressive treatments among Stage IV early-onset colorectal cancer patients.”