Chemotherapy Regimen in Nonagenarian Cancer Patients: A Bi-Institutional Experience

Abstract

Background: The elderly population in Western countries is growing and constitutes a public health issue. Concomitantly, age-related diseases such as cancer increase. There are few data on the efficacy, tolerability and toxicity of specific anticancer therapy in the very elderly patients; therefore, their management is not standardized. Methods: In this bi-institutional study, we reviewed medical records of patients who received or continued specific anticancer therapy beyond the age of 90 years. Geriatric assessment was not reported for our patients. Twelve patients were enrolled. Their general health condition was good, and half of them were living in elderly institutions. Ten patients had a solid tumor and 2 were treated for hematological malignancies. Most were diagnosed with a locally advanced or metastatic disease, and the goal of treatment was curative for only 1 patient. Six patients received chemotherapy as first-line treatment, 4 patients received targeted therapy and 2 received concomitant chemoradiation. Four patients received a second-line treatment. Results: Despite a significant reduction in treatment posology in half of the patients, 8 acute grade 3/4 toxicities were reported and 2 patients died of treatment-related septic shock. Median duration of first-line treatment was 3.2 months, and progression-free survival ranged from 18 to 311 days. Overall survival ranged from 18 days to 11 years. Conclusion: Aging is a heterogeneous process, and management of elderly patients is a multidisciplinary approach. Geriatric assessment helps to identify older patients with a higher risk of morbidity/mortality and allows to assess the risks and benefits of specific anticancer therapy. The choice of treatment should be based primarily on the expected symptomatic benefit, and treatment should not compromise the quality of life.

Functional impairment and serum albumin predict in-hospital mortality in nonagenarians with acute infection: a retrospective cohort study

“…However, these populations are generally excluded from most clinical trials. Due to this lack of evidence in the nonagenarian population, general clinical practice for this population has gained considerable attention during recent years, with clinical trials including nonagenarians mainly focused on the fields of surgery [3–7], chemotherapy [8], interventional operation [9–12] and trauma [13], in the departments of orthopedics, vascular surgery, general surgery, and oncology, rather than a department of internal medicine. In real-world clinical practice, about one-third of the patients over 90 years old have been admitted to an internal medicine department [14].…”

Radiotherapy for nonagenarians: the value of biological versus chronological age

“…In most cases, chemotherapy was initiated prior to radiotherapy and continued during the course of radiation treatment. Rivoirard and colleagues investigated the efficacy and safety of systemic treatments among nonagenarian cancer patients [28]. Although the general condition of these patients was relatively good and chemotherapy dosages were significantly reduced in about half of the patients, 8 of 12 patients experienced acute grade 3-4 toxicities, and 2 died of complications related to chemotherapy, thus demonstrating the difficulty of applying chemotherapy in this frail patient group.…”

Do we know what to do with our nonagenarian and centenarian patients with metastatic colorectal cancer (mCRC)? Results from the South Australian mCRC registry

“…The difficulty with all of these analyses is that patients aged between 80 and 90 years were also included. Rivoirard et al [29] have attempted to assess a nonagenarian population from two institutions, although they have included multiple cancer types, including hematological malignancies, and only included 12 patients. Only three patients with mCRC diagnosis were included in the study.…”