Older versus younger adults with gastric cancer receiving perioperative treatment: Results from the CRITICS trial

Abstract

To evaluate treatment-related toxicity, treatment compliance, surgical complications and event-free survival (EFS) in older (70 years) versus younger (<70 years) adults who underwent perioperative treatment for gastric cancer. Methods: In the CRITICS trial, 788 patients with resectable gastric cancer were randomised before start of any treatment and received preoperative chemotherapy (3 cycles of epirubicin, cisplatin or oxaliplatin and capecitabine), followed by surgery, followed by either postoperative chemotherapy or chemoradiotherapy (45Gy þ cisplatin þ capecitabine). Results: 172 (22%) patients were older adults. During preoperative chemotherapy, 131 (77%) older adults versus 380 (62%) younger adults experienced severe toxicity (p < 0.001); older adults received significantly lower relative dose intensities (RDIs) for all chemotherapeutic drugs. Equal proportions of older versus younger adults underwent curative surgery: 137 (80%) versus 499 (81%), with comparable postoperative complications and postoperative mortality. Postoperative therapy after curative surgery started in 87 (64%) older adults versus 391 (78%) younger adults (p < 0.001). Incidence of severe toxicity during postoperative chemotherapy was 22 (54%) in older adults versus 113 (59%) in younger adults (p Z 0.541); older adults received significantly lower RDIs for all chemotherapeutic drugs. Severe toxicity rates for postoperative chemoradiotherapy were 22 (48%) older adults versus 89 (45%) for younger adults (p Z 0.703), with comparable chemotherapy RDIs and radiotherapy dose. Two-year EFS was 53% for older adults versus 51% for younger adults. Conclusion: Perioperative treatment compliance, especially in the postoperative phase, was poorer in older adults compared with younger adults. As comparable proportions of patients underwent curative surgery, future studies should focus on neo-adjuvant treatment. Trial registration: ClinicalTrials.gov identifier: NCT00407186. EudraCT number: 2006 e00413032.

A case-control study of a combination of single nucleotide polymorphisms and clinical parameters to predict clinically relevant toxicity associated with fluoropyrimidine and platinum-based chemotherapy in gastric cancer

“…In contrast, a pooled analysis concluded that chemotherapy-related serious adverse events were significantly higher in > 65 year-old patients [65]. Accordingly, a recent study demonstrated that older GC patients (≥ 70) experience more severe toxicities versus younger patients [66]. A number of studies, including meta-analyses, have shown an increased risk of severe toxicity associated to fluoropyrimidine/platinum-based chemotherapy in female gastric and colorectal cancer patients [7,36,37,67].…”

<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

“…Therefore, perioperative treatment compliance, especially in the postoperative phase, was poorer in older adults when compared with younger. 28 This may be one of the reasons why older age is associated with worse cancer-specific mortality in the perioperative therapy setting that is recommended in Europe.…”

Impact of neoadjuvant therapy followed by laparoscopic radical gastrectomy with D2 lymph node dissection in Western population: A multi‐institutional propensity score‐matched study

“…In fact, we demonstrated that the difference in complication rate between NAT and US group is relevant over 60 years old ( p = 0.013) but not in younger patients ( p = 0.620). Although it has been previously demonstrated that age is a significant predictor of postoperative complications, 42–44 it is still controversial if NAT could negatively affect short‐term outcomes in older patients as reported by Fujitani et al 45 or not 46 …”