More Aggressive Therapy Not Warranted for Early Onset Colorectal Cancer

By Reuters Staff

August 19, 2021

NEW YORK (Reuters Health) - Colorectal cancers that develop before age 49 are similar clinically and biologically to CRCs that develop after age 50, according to the largest and most comprehensive evaluation of early-onset versus average-onset CRC.

Therefore, "aggressive treatment regimens based solely on the age at CRC diagnosis are not warranted," say Dr. Andrea Cercek and colleagues from Memorial Sloan Kettering Cancer Center in New York.

The incidence of early-onset CRC has been increasing and it's unclear why. While earlier research suggested that early-onset CRC was inherently more aggressive, additional treatment for patients with early-onset CRC has not improved survival, the researchers note in the Journal of the National Cancer Institute.

To see if early-onset CRC is different from CRC, they reviewed clinical, histopathologic and genomic characteristics of 759 patients with early-onset CRC (diagnosed at age 35 to 49 years) compared with 687 CRC patients diagnosed at age 50 or older.

Patients with early-onset CRC were more likely to have tumors on the left side, to experience rectal bleeding and abdominal pain, and to have a higher risk of inherited genetic predisposition for the disease.

But the two groups were indistinguishable from each other with regard to the genetic make-up of their tumors and their response to treatment, suggesting that aggressive treatment for early-onset CRC is unnecessary, Dr. Cercek and colleagues conclude.

"In contrast to prior reports, after adjustment for known confounders, neither genomic tumor profiles nor clinical outcome data support the hypothesis that sporadic early-onset CRC is biologically distinct from sporadic average-onset CRC," they report.

SOURCE: Journal of the National Cancer Institute, online August 18, 2021.