Δευτέρα, 22 Φεβρουαρίου 2016

NO BENEFIT OF GERIATRIC ASSESSMENT IN NSCLC

Allocating chemotherapy treatment based on a comprehensive geriatric assessment (CGA) failed to improve treatment failure-free survival (TFFS) or overall survival (OS) in elderly patients with advanced non–small-cell lung cancer (NSCLC), according to a new study. The strategy did slightly reduce treatment toxicity. 
“In clinical practice, elderly patients form a heterogeneous population with baseline organ dysfunctions and with variable numbers of comorbidities correlating poorly with functional status,” wrote study authors led by Romain Corre, MD, of Centre Hospitalier Universitaire de Rennes in France. Following clinical guidelines in these patients can be particularly difficult.
The CGA is a multidisciplinary approach that includes functional status, cognitive function, emotional status, comorbidities, nutritional status, polypharmacy, social and environmental situations, and assessment for geriatric syndrome.
The new study randomized 494 patients aged 70 years or older to standard chemotherapy allocation based on performance status and age (251 patients) or a CGA group (243 patients). In the latter, frail patients received best supportive care, “vulnerable” patients received docetaxel, and fit patients received either a carboplatin/pemetrexed regimen or a carboplatin/gemcitabine regimen. The results were published online ahead of print in the Journal of Clinical Oncology.
There was no difference between the two groups with regard to TFFS, at 3.2 months with standard care and 3.1 months with CGA-based care, for a hazard ratio of 0.91 (95% CI, 0.76–1.1; P = .32). Treatment failure was more frequently a result of toxicity in the standard arm than in the CGA arm (11.8% vs 4.8%; P = .007).
Progression-free survival also did not differ, at 3.7 months for standard and 3.4 months for CGA patients (P = .59). The same was true of OS, at 6.4 months for standard care and 6.1 months for CGA (P = .87). Objective response rates also did not differ.
The only area where CGA-guided therapy did offer an advantage was in regard to adverse events (AEs). Overall, more patients in the standard group experienced an AE of any grade (93.4% vs 85.6%; P = .015). This was not significant, however, when only grade 3 or 4 toxicities were considered (71.3% vs 67.9%; P = .41). There was also some suggestion of benefit for quality of life with CGA, though only at one time point (36 weeks) did this reach significance.
“CGA-based allocation of chemotherapy did not improve the survival outcomes of elderly patients with advanced NSCLC,” the authors wrote. “Consequently, the use of CGA in this setting cannot be routinely advised in clinical practice.” They added that further research could identify specific tools within the CGA that could help guide treatment in advanced NSCLC.

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