| Abstract |
The aim of the current study was to evaluate the role of a Comprehensive
Geriatric Assessment (CGA) and its domains, such as functional independence,
comorbidity, polypharmacy, depression, cognitive impairment, malnutrition and
presence of geriatric syndromes as prognostic and provleptic tools in elderly patients
with advanced non-small cell lung cancer (NSCLC) receiving chemotherapy.
Cancer is a disease of the elderly with 60% of new diagnosis and 70% of
cancer deaths occuring in patients over the age of 65 years. Lung cancer is the
commonest type of cancer in developed world and the leading cause of cancer deaths
with a median age at diagnosis of 71 years in US. NSCLC representing 85% of lung
cancer cases is usually diagnosed in advanced stage, where combination
chemotherapy offers a survival benefit in molecular-unselected patients with good
perfomance status. Older patients are under-represented in clinical trials while data
from elderly-specific trials are conflicting. Therefore, the optimal management for
this population remains unclear.
Ageing is a highly individualized process and the chronologic age does not
always reflect the actual “biologic” age. Olders consists a heterogeneous population
depending on their model of ageing. A CGA is proposed for the multidimensional
assessment of elders, consisted of validated questionnaires and instruments for the
evaluation of functional, emotional and cognitive status, the comorbid diseases, the nutritional status, polypharmacy, presence of geriatric syndromes and socio-economic
issues, aiming to guide personalized treatment decision.
In this study, 201 patients with advanced NSCLC receiving first-line (n=138)
or salvage chemotherapy (n=63) within five phase II and III elderly-specific trials
condacted by the Hellenic Oncology Researsh Group (HORG) were prospectively
assessed with a baseline CGA and categorised into three groups, as fit (30,3%)
vulnerable (45,8%) or frail (23,9%), according to Balducci criteria. Median age was
75 years (range 65-92), while 53% and 42% were over the age of 75 and 80 years,
respectively.
The univariate and multivariate analysis of CGA domains indicated a
significant correlation for severe treatment-related toxicity with age ≥ 75 years,
impaired ECOG PS of 2, non-fitness according to CGA and treatment with
combination of a classic cytotoxic and a biologic agent, while disease stage and
combination treatment were significantly correlated with response to treatment.
ECOG PS, combination treatment and cognitive status were identified as significant
prognostic factors for survival.
The results of the current study revealed that a CGA in older patients with
advanced NSCLC is feasible and offers valuable prognostic information for treatment
toxicity and survival that can help individualize treatment decision in everyday
clinical practice. In addition, the study results can contribute to future clinical
research by using the identified prognostic biomarkers as stratification factors of older
patients participating in clinical trials but also as domains that merit furter evaluation
within ongoing research on the development of optimal tools for geriatric assessment.
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Πολυδιάστατη γηριατρική αξιολόγηση και εκτίμηση ποιότητας ζωής και ανοχής στη θεραπεία σε ηλικιωμένους ασθενείς με ανεγχείρητο μη-μικροκυτταρικό καρκίνο πνεύμονα που υποβάλλονται σε χημειοθεραπεία
