Safety and Efficacy of a First-Line Chemotherapy Tailored by G8 Score in Elderly Metastatic or Locally Advanced Gastric and Gastro-Esophageal Cancer Patients: A Real-World Analysis

Introduction: Gastric (GC) and gastro-esophageal cancer (GEC) are common neoplasms in the elderly. However, in clinical practice, the correct strategy for elderly patients who might benefit from chemotherapy (CT) is unknown. Prospective data are still poor. In this context, we performed a retrospective analysis of GC patients aged ≥75 years and treated at our institutions. Material and Methods: We retrospectively analyzed 90 patients with confirmed metastatic GC or GEC, treated with an upfront CT. Inclusion criteria were patients aged ≥75 years, PS 0–2, normal bone marrow/liver/renal function and no major comorbidities. All patients received a G8 score, and some patients with G8 ≤14 received a comprehensive geriatric assessment (CGA). The primary goal was to perform a safety evaluation based on the incidence of adverse events (AE), and the secondary goal was to determine the efficacy (PFS and OS). The chi-square test and the Kaplan–Meier method were used to estimate the outcomes. The statistical significance level was set at p < 0.05. Results: Toxicity rates were quite low: G1/G2 (51.1%) and G3/G4 (25.5%). No toxic deaths were reported. The median PFS was 6.21 months and the median OS 11 months. The G8 score and PS ECOG significantly influenced both PFS and OS. A statistically significant correlation among G8, weight loss, hypoalbuminemia and risk of G3/G4 adverse events was also found. Conclusion: Our research on selected elderly patients did not detect broad differences of efficacy and tolerability compared to a young population. Our study, although retrospective and small-sized, showed that G8 score might be an accurate tool to identify elderly GC/GEC patients who could be safely treated with CT, further recognizing patients who could receive a doublet CT and who may require a single agent chemotherapy or a baseline dose reduction

Onco-geriatric approach for the management of older patients with cancer.

INTRODUCTION AND RATIONALE: The number of older cancer patients is increasing with global aging of the population. A close interaction between oncologists and geriatricians becomes necessary to (1) better evaluate the elders' health status, (2) determine their residual clinical/biological reserves, and (3) optimize the provided medical care. In fact, aggressive antineoplastic managements are often denied to older patients, possibly because of the common misconception suggesting older age and/or clinical complexity as absolute contraindications to advanced treatments. METHODS: The primary aim of the presented project is to assess whether assigning a geriatrician to provide daily medical care to older cancer patients (aged 65 years and older) admitted to an oncology ward increases the number of patients eligible for a chemotherapeutic and/or surgical intervention. The project is articulated in 2 phases: (1) a retrospective phase based on analysis of data collected over the 2 years before the beginning of the study, and (2) a prospective 2-year intervention. Additional information about clinical conditions, biological parameters, adverse drug reactions, body composition, physical function, and 1-year health-related events will also be recorded. OUTCOMES: The combination of expertise from oncologists and geriatricians is likely to result in (1) an improved selection of candidates for interventions aimed at increasing disability-free life expectancy and/or overall survival, and (2) a more rational exclusion of patients at higher risk of toxicity or with poor prognosis. In this article, the development of an onco-geriatric unit aimed at the evaluation, management, and treatment of older women with gynecological cancer is also described

Relation between drug therapy-based comorbidity indices, Charlson's comorbidity index, polypharmacy and mortality in three samples of older adults.

Background: Comorbidity indexes were designed in order to measure how the disease burden of a patient is related to different clinical outcomes such as mortality, especially in older and intensively treated people. Charlson's Comorbidity Index (CCI) is the most widely used rating system, based on diagnoses, but when this information is not available therapy-based comorbidity indices (TBCI) are an alternative: among them, Drug Derived Complexity Index (DDCI), Medicines Comorbidity Index (MCI), and Chronic Disease Score (CDS) are available. Aims: This study assessed the predictive power for 1-year mortality of these comorbidity indices and polypharmacy. Methods: Survival analysis and Receiver Operating Characteristic (ROC) analysis were conducted on three Italian cohorts: 2,389 nursing home residents (Korian), 4,765 and 633 older adults admitted acutely to geriatric or internal medicine wards (REPOSI and ELICADHE). Results: Cox's regression indicated that the highest levels of the CCI are associated with an increment of 1-year mortality risk as compared to null score for all the three samples. DDCI and excessive polypharmacy gave similar results but MCI and CDS were not always statistically significant. The predictive power with the ROC curve of each comorbidity index was poor and similar in all settings. Conclusion: On the whole, comorbidity indices did not perform well in our three settings, although the highest level of each index was associated with higher mortality