GERIATRIC FACTORS PREDICTING CHEMOTHERAPY MORBIDITY 

J Clin Oncol. 2013 Mar 4. [Epub ahead of print]

Geriatric Factors Predict Chemotherapy Feasibility: Ancillary Results of FFCD 2001-02 Phase III Study in First-Line Chemotherapy for Metastatic Colorectal Cancer in Elderly Patients.

Aparicio T, Jouve JL, Teillet L, Gargot D, Subtil F, Le Brun-Ly V, Cretin J, Locher C, Bouché O, Breysacher G, Charneau J, Seitz JF, Gasmi M, Stefani L,Ramdani M, Lecomte T, Mitry E.

Source

Thomas Aparicio, Avicenne Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université Paris 13, Sorbonne Paris Cité, Bobigny; Laurent Teillet, Sainte Perine Hospital, AP-HP; Emmanuel Mitry, Institut Curie, Versaille Saint Quentin University, Paris; Jean-Louis Jouve, Centre Hospitalier Universitaire (CHU) Dijon; Fabien Subtil, Fédération Francophone de Cancérologie Digestive, Dijon; Dany Gargot, Centre Hôspitalier (CH) Blois, Blois; Valérie Le Brun-Ly, CHU Limoges, Limoges; Jacques Cretin, CH Ales, Ales; Christophe Locher, CH Meaux, Meaux; Olivier Bouché, CHU Robert Debre, Reims; Gilles Breysacher, CH Colmar Colmar; Jacky Charneau, CH Boulogne-sur-Mer, Boulogne-sur-Mer; Jean-François Seitz, Timone Hospital, Assistance Publique-Hopitaux de Marseille (AP-HM); Mohamed Gasmi, Hôpital Nord, AP-HM, Marseille; Laetitia Stefani, CH Pringy, Pringy; Mohamed Ramdani, CH Bezier, Bezier; and Thierry Lecomte, CHU Trousseau, Université François-Rabelais, Tours, France.

Abstract

PURPOSEElderly patients form a heterogeneous population. Evaluation of geriatric factors may help evaluate a patient's health status to better adapt treatment. PATIENTS AND METHODSElderly patients with previously untreated metastatic colorectal cancer (mCRC) were randomly assigned to receive fluorouracil (FU) -based chemotherapy either alone or in combination with irinotecan (IRI) in the Fédération Francophone de Cancérologie Digestive (FFCD) 2001-02 study. Sites participating in the geriatric substudy completed geriatric screening tools to perform prognostic factor analyses for treatment safety during the first 4 months after treatment initiation.ResultsThe geriatric score was calculated in 123 patients (44%). Median age was 80 years (range, 75 to 91 years). The Charlson comorbidity index was ≤ 1 in 75%, Mini-Mental State Examination (MMSE) score was ≤ 27/30 in 31%, and Instrumental Activities of Daily Living (IADL) showed impairment in 34% of the patients. Seventy-one patients (58%) had grade 3 to 4 toxicity, 41 (33%) had a dose-intensity reduction of more than 33%, and 54 (44%) had at least one unexpected hospitalization during the first 4 months after starting treatment. In multivariate analysis, significant predictive factors for grade 3-4 toxicity were IRI arm (odds ratio [OR], 5.03), MMSE ≤ 27/30 (OR, 3.84), and impaired IADL (OR, 4.67); for dose-intensity reduction of > 33%, the significant predictive factors were alkaline phosphates > 2 × upper limit of normal (OR, 4.16) and IRI arm (OR, 6.85); and for unexpected hospitalization, significant predictive factors were MMSE ≤ 27/30 (OR, 4.56) and Geriatric Depression Scale ≤ 2 (OR, 5.52). CONCLUSIONGeriatric factors (MMSE and IADL) are predictive of severe toxicity or unexpected hospitalization (MMSE) in a randomized prospective phase III study in mCRC. These results suggest that cognitive function and autonomy impairment should be taken into account when choosing a regimen for chemotherapy.