Evaluation post-commercialisation des médicaments en oncogériatrie : application au traitement du cancer colorectal métastatique

Abstract : In France, in 2012, patients aged at least 65 years accounted for 71% of the incidence of ColoRectal Cancer (CCR). Since 2005, targeted therapies have been authorized in metastatic CRC (mCRC) and are recommended in first-line in combination with conventional chemotherapy. Given this lack of evaluation of these drugs in the elderly, the objective of this work was the study, in real-life setting, of the use, the benefits and the safety of anticancer drugs, including targeted therapies in elderly and/or frail mCRC patients. A systematic review of the literature confirmed the low inclusion of elderly and frail patients in clinical trials evaluating targeted therapies in the mCRC. According to a study on international pharmacovigilance data and the pooling of two field cohorts of patients treated by targeted therapies, we showed that their effectiveness and safety in the elderly were equivalent to those of the younger. In the cohort, frailty regarding serious adverse events and death was related to the characteristics of the mCRC. Finally, according to a pilot field study and a cohort in the French health insurance data, we have shown that, in the elderly, the treatment with anticancer drugs, including targeted therapies, was not optimal and still very related to the age of the patients. The benefit/risk ratio of targeted therapies therefore seems positive in the elderly population with mCRC currently treated. However, the elderly population treated does not seem to be fully matching with those who would benefit from treatment.
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Amandine Andrée Denise Suzanne Gouverneur. Evaluation post-commercialisation des médicaments en oncogériatrie : application au traitement du cancer colorectal métastatique. Médecine humaine et pathologie. Université de Bordeaux, 2017. Français. ⟨NNT : 2017BORD0887⟩. ⟨tel-02145206⟩

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