Predictive factors for chemotherapy feasibility in elderly patients with solid tumor: Results of GERCOR old prospective multicenter study.

Abstract

9511 Background: One quarter of patients with cancer are 75 year old and over. Previous studies suggested that geriatric parameters improved survival in elderly patients with solid advanced cancer and chemotherapy severe toxicity. A simplified scale would be helpful for oncologist to predict chemotherapy feasibility. The aim was to identify geriatric predictors of chemotherapy feasibility in chemo-naïve elderly patients. Methods: We conducted a prospective multicenter cohort study (NCT00664911). Inclusion criteria were: ≥ 75 years, solid tumor, able to receive at least 2/3 of the standard dose at the first course of treatment. Ten geriatric parameters were recorded at baseline by the oncologist: 1-three words test, 2-date and address for cognitive function, 3-Instrumental Activities of Daily Living (IADL), 4- monopodal stand-up test, 5-hospitalization during the previous year, 6-number of medicines taken for comorbidities, 7-creatinine clearance, 8-albumin serum level, 9-self-rated depressive mood question and 10-presence of a caregiver. The main outcome was chemotherapy feasibility defined by the ability to receive at least 3 months of the planned therapy. Multivariate logistic regression was used. Results: 576 patients were included in 49 centers from 2008 to 2012, 516 (89.6%) were eligible for analysis. Mean age was 81 years, 50.6% had colorectal cancer, 69.5% advanced stage and 83.6% had performance status 0-1. Chemotherapy feasibility was observed in 298 (57.8%) patients. Grade 3-4 toxicity was observed in 26.2% of patients. In multivariate analysis albuminemia < 30g/l (adjusted OR =2.34 CI95% [1.43-3.83]) and depressive mood (adjusted OR=1.55 CI95% [1.02-2.35]) were significantly associated with chemotherapy unfeasibility whereas others geriatrics parameters were not. Conclusions: Albuminemia and self rated depressive mood status were independently predictive for chemotherapy feasibility in elderly patients with solid tumor. Unexpectedly others geriatrics parameters were not independent predictors. Clinical trial information: NCT00664911.

Chemotoxicity recurrence in older patients: Risk factors and effectiveness of preventive strategies—a prospective study

“…Recently, several models have become available that may assist with decision-making. 3,14,15,19 Some aim at predicting the risk of severe toxicity according to CTCAE, 3,14 whereas others have focused on the ability of the patient to complete chemotherapy. 15,19 Collectively, these models highlight the importance of considering geriatric parameters when planning chemotherapy.…”

“…3,14,15,19 Some aim at predicting the risk of severe toxicity according to CTCAE, 3,14 whereas others have focused on the ability of the patient to complete chemotherapy. 15,19 Collectively, these models highlight the importance of considering geriatric parameters when planning chemotherapy. Future research should focus on the best way to use these models in clinical trial design, so that an appropriate chemotherapy dose can be given at the first cycle that is both high enough to be effective and low enough to decrease the important dropout rate due to severe initial complications.…”