Palliative chemotherapy in elderly patients with common metastatic
malignancies: A Hellenic Cooperative Oncology Group registry analysis of
management, outcome and clinical benefit predictors
Introduction: Cancer in the elderly is a common health issue in
developed societies. We sought to present epidemiology, management and
outcome data on fit elderly patients with common metastatic cancers and
to identify predictors of clinical benefit from palliative chemotherapy.
Methods: All patients aged >65 years who were diagnosed with metastatic
breast, colorectal or non-small cell lung carcinomas and managed with
palliative chemotherapy in the context of Hellenic Cooperative Oncology
Group (HeCOG) clinical trials or protocols were eligible for electronic
data retrieval and analysis. Common eligibility criteria included
adequate performance status (ECOG 0-3), organ function and absence of
severe co-morbidity forbidding cytotoxic chemotherapy.
Results: One thousand three hundred and seventy-two fit patients (PS 0-1
in 73%) with a median age of 70 years diagnosed with metastatic breast
(n = 250), colorectal (n = 621) or lung cancer (n = 501) received
chemotherapy from 1991 until 2006. Most patients received modem
full-dose chemotherapy regimens including platinum, taxanes,
anthracyclines, fluoropyrimidines, oxaliplatin or irinotecan. Mild to
moderate co-morbidity was present in 35%. At a median follow-up of 3
years, objective responses were seen in 41% of patients with breast
cancer, 25% with colorectal cancer and 31% with lung cancer, while
median survival was 21, 16 and 9.4 months, respectively. Grade 3 or 4
toxicity was seen in a quarter of patients, the most common being
neutropenia (14%), diarrhoea (6%), neurotoxicity (4%), fatigue,
nausea and febrile neutropenia (each 2%). In multivariate analysis,
diagnosis of colorectal or lung cancer, metastases in multiple organ
sites, presence of liver/brain/peritoneal deposits, impaired PS and low
baseline serum albumin levels were prognostic factors for adverse
outcome. The same factors excluding metastatic sites and with the
addition of anemia predicted for resistance to chemotherapy. Toxicity
was more likely in females with low serum albumin and renal dysfunction.
A six-variable geriatric assessment for palliation (GAP) score that
included tumour type, sites of metastatic dissemination, impaired PS,
low serum albumin and anemia classified elderly patients to groups with
low, intermediate and high risk for disease progression and death
(relative risks of 1.59 and 2.50 for resistance to therapy and 1.87 and
3.12 for death in the intermediate and high-risk groups).
Conclusions: Our data indicate that relatively fit elderly patients with
advanced cancer safely tolerate modern chemotherapy and enjoy disease
control in a manner comparable to younger patients. Our GAP score, if
further validated, offers promise for geriatric application in
combination to comprehensive geriatric assessment tools for the
optimisation of palliative therapy on an individualised basis. (C) 2007
Elsevier Ireland Ltd. All rights reserved
