Prediction of unplanned hospitalizations in older patients treated with chemotherapy

Purpose: To determine the incidence of unplanned hospitalization (UH) and to identify risk factors for UH in elderly patients with cancer who start chemotherapy. Methods: In all, 493 patients over 70 years starting new chemotherapy regimens were prospectively included. A pre-chemotherapy geriatric assessment was performed, and tumor and treatment variables were collected. The association between these factors and UH was examined by using multivariable logistic regression. Score points were assigned to each risk factor. Results: During the first 6 months of treatment, 37% of patients had at least one episode of UH. Risk factors were the use of combination chemotherapy at standard doses, a MAX2 index ≥1, a Charlson comorbidity score ≥2, albumin level <3.5 g/dL, falls in the past 6 months ≥1, and weight loss >5%. Three risk groups for UH were established according to the score in all patients: 0–1: 17.5%; 2: 34%; and 3–7: 57% (p < 0.001). The area under receiver operation characteristic (ROC) curve was 0.72 (95% CI: 0.67–0.77). Conclusion: This simple tool can help to reduce the incidence of UH in elderly patients with cancer who are scheduled to initiate chemotherapy treatmen

Development and Validation of an Early Mortality Risk Score for Older Patients Treated with Chemotherapy for Cancer

Background: Estimation of life expectancy in older patients is relevant to select the best treatment strategy. We aimed to develop and validate a score to predict early mortality in older patients with cancer. Patients and Methods: A total of 749 patients over 70 years starting new chemotherapy regimens were prospectively included. A prechemotherapy assessment that included sociodemographic variables, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and early death was examined using multivariable logistic regression. Score points were assigned to each risk factor. External validation was performed on an independent cohort. Results: In the training cohort, the independent predictors of 6-month mortality were metastatic stage (OR 4.8, 95% CI [2.4-9.6]), ECOG-PS 2 (OR 2.3, 95% CI [1.1-5.2]), ADL ≤ 5 (OR 1.7, 95% CI [1.1-3.5]), serum albumin levels ≤ 3.5 g/dL (OR 3.4, 95% CI [1.7-6.6]), BMI < 23 kg/m2 (OR 2.5, 95% CI [1.3-4.9]), and hemoglobin levels < 11 g/dL (OR 2.4, 95% CI (1.2-4.7)). With these results, we built a prognostic score. The area under the ROC curve was 0.78 (95% CI, 0.73 to 0.84), and in the validation set, it was 0.73 (95% CI: 0.67-0.79). Conclusions: This simple and highly accurate tool can help physicians making decisions in elderly patients with cancer who are planned to initiate chemotherapy treatment

β-(Z) selectivity control by cyclometalated rhodium(III)–triazolylidene homogeneous and heterogeneous terminal alkyne hydrosilylation catalysts

The cyclometalated Rh(III)–NHC compounds [Cp*RhI(C,C′)-Triaz] (Triaz = 1,4-diphenyl-3-methyl-1,2,3-triazol-5-ylidene) and [Cp*RhI(C,C′)-Im] (Im = 1-phenyl-3-methyl-imidazol-2-ylidene) are efficient catalysts for the hydrosilylation of terminal alkynes with complete regio- and stereoselectivity toward the thermodynamically less stable β-(Z)-vinylsilane isomer at room temperature in chloroform or acetone. Catalyst [Cp*RhI(C,C′)-Triaz] shows a superior catalytic performance in terms of activity and has been applied to the hydrosilylation of a range of linear 1-alkynes and phenylacetylene derivatives with diverse hydrosilanes, including HSiMePh2, HSiMe2Ph, HSiEt3, and the bulkier heptamethylhydrotrisiloxane (HMTS), to afford the corresponding β-(Z)-vinylsilanes in quantitative yields. The graphene-based hybrid material TRGO-Triaz-Rh(III), featuring cyclometalated [Cp*RhI(C,C′)-Triaz] (Triaz = 1,4-diphenyl-3-methyl-1,2,3-triazol-5-ylidene) rhodium(III) complexes covalently immobilized through the triazolylidene linker, has been prepared by metalation of the trimethylsilyl-protected 3-methyl-4-phenyl-1,2,3-triazolium iodide functionalized graphene oxide material, TRGO-Triaz, with [Cp*RhCl2]2 using sodium tert-butoxide as base. The coordination sphere of the supported rhodium(III) complexes has been determined by means of XPS and extended X-ray absorption fine structure (EXAFS) spectroscopy, showing the replacement of the iodido ligand by O-functionalities on the carbon wall. In sharp contrast with the homogeneous catalyst, the heterogeneous hybrid catalyst TRGO-Triaz-Rh(III) is not active at room temperature although it shows an excellent catalytic performance at 60 °C. In addition, the hybrid catalyst TRGO-Triaz-Rh(III) has shown an excellent recyclability, allowing at least six catalytic runs in the hydrosilylation of oct-1-yne with HSiMePh2 in acetone with complete selectivity to the β-(Z)-vinylsilane product. The reaction mechanism for the molecular catalyst [Cp*RhI(C,C′)-Triaz] has been explored by means of DFT calculations, pointing to a metal–ligand bifunctional mechanism involving reversible cyclometalation that is competitive with a noncooperative pathway. The proposed mechanism entails the Rh–CAr assisted hydrosilane activation to afford a reactive Rh–silyl intermediate that leads to a (E)-silylvinylene intermediate after alkyne insertion and a metallacyclopropene-driven isomerization. The release of the β-(Z)-vinylsilane product can occur by a reversible cyclometalation mechanism involving σ-CAM with the CAr–H bond or, alternatively, the Si–H bond of an external hydrosilane. The energy barrier for the latter is 1.2 kcal·mol–1 lower than that of the CAr–H bond, which results in a small energy span difference that makes both pathways competitive under catalytic conditions.The authors express their appreciation for the financial support from MICINN/FEDER, projects PID2019-103965GB-100, CTQ2016-75884-P and RTI2018-098537-B-C22, DGA/FEDER 2014-2020 “Building Europe from Aragón” (groups E42_20R and E12_20R), and Principado de Asturias/FEDER (IDI/2018/000121).Peer reviewe