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Friedman CF, Manning-Geist BL, Zhou Q, Soumerai T, Holland A, Da Cruz Paula A, Green H, Ozsoy MA, Iasonos A, Hollmann T, Leitao MM, Mueller JJ, Makker V, Tew WP, O'Cearbhaill RE, Liu YL, Rubinstein MM, Troso-Sandoval T, Lichtman SM, Schram A, Kyi C, Grisham RN, Causa Andrieu P, Wherry EJ, Aghajanian C, Weigelt B, Hensley ML, Zamarin D. Nivolumab for mismatch-repair-deficient or hypermutated gynecologic cancers: a phase 2 trial with biomarker analyses. Nat Med 2024:10.1038/s41591-024-02942-7. [PMID: 38653864 DOI: 10.1038/s41591-024-02942-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
Programmed death-1 (PD-1) inhibitors are approved for therapy of gynecologic cancers with DNA mismatch repair deficiency (dMMR), although predictors of response remain elusive. We conducted a single-arm phase 2 study of nivolumab in 35 patients with dMMR uterine or ovarian cancers. Co-primary endpoints included objective response rate (ORR) and progression-free survival at 24 weeks (PFS24). Secondary endpoints included overall survival (OS), disease control rate (DCR), duration of response (DOR) and safety. Exploratory endpoints included biomarkers and molecular correlates of response. The ORR was 58.8% (97.5% confidence interval (CI): 40.7-100%), and the PFS24 rate was 64.7% (97.5% one-sided CI: 46.5-100%), meeting the pre-specified endpoints. The DCR was 73.5% (95% CI: 55.6-87.1%). At the median follow-up of 42.1 months (range, 8.9-59.8 months), median OS was not reached. One-year OS rate was 79% (95% CI: 60.9-89.4%). Thirty-two patients (91%) had a treatment-related adverse event (TRAE), including arthralgia (n = 10, 29%), fatigue (n = 10, 29%), pain (n = 10, 29%) and pruritis (n = 10, 29%); most were grade 1 or grade 2. Ten patients (29%) reported a grade 3 or grade 4 TRAE; no grade 5 events occurred. Exploratory analyses show that the presence of dysfunctional (CD8+PD-1+) or terminally dysfunctional (CD8+PD-1+TOX+) T cells and their interaction with programmed death ligand-1 (PD-L1)+ cells were independently associated with PFS24. PFS24 was associated with presence of MEGF8 or SETD1B somatic mutations. This trial met its co-primary endpoints (ORR and PFS24) early, and our findings highlight several genetic and tumor microenvironment parameters associated with response to PD-1 blockade in dMMR cancers, generating rationale for their validation in larger cohorts.ClinicalTrials.gov identifier: NCT03241745 .
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Affiliation(s)
- Claire F Friedman
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
- Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Beryl L Manning-Geist
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tara Soumerai
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aliya Holland
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Arnaud Da Cruz Paula
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hunter Green
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melih Arda Ozsoy
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Travis Hollmann
- Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Vicky Makker
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - William P Tew
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Roisin E O'Cearbhaill
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ying L Liu
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Maria M Rubinstein
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Tiffany Troso-Sandoval
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Stuart M Lichtman
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Alison Schram
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Chrisann Kyi
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Rachel N Grisham
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Pamela Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E John Wherry
- Institute of Immunology,University of Pennsylvania, Philadelphia, PA, USA
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martee L Hensley
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Dmitriy Zamarin
- Tisch Cancer Institute,Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Praiss AM, Miller A, Smith J, Lichtman SM, Bookman M, Aghajanian C, Sabbatini P, Backes F, Cohn DE, Argenta P, Friedlander M, Goodheart MJ, Mutch DG, Gershenson DM, Tewari KS, Wenham RM, Wahner Hendrickson AE, Lee RB, Gray H, Secord AA, Van Le L, O'Cearbhaill RE. Carboplatin dosing in the treatment of ovarian cancer: An NRG oncology group study. Gynecol Oncol 2023; 174:213-223. [PMID: 37229879 PMCID: PMC10330633 DOI: 10.1016/j.ygyno.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine the effects of using National Comprehensive Cancer Network (NCCN) guidelines to estimate renal function on carboplatin dosing and explore adverse effects associated with a more accurate estimation of lower creatinine clearance (CrCl). METHODS Retrospective data were obtained for 3830 of 4312 patients treated on GOG182 (NCT00011986)-a phase III trial of platinum-based chemotherapy for advanced-stage ovarian cancer. Carboplatin dose per patient on GOG182 was determined using the Jelliffe formula. We recalculated CrCl to determine dosing using Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault (with/without NCCN recommended modifications) formulas. Associations between baseline CrCl and toxicity were described using the area under the receiver operating characteristic curve (AUC). Sensitivity and positive predictive values described the model's ability to discriminate between subjects with/without the adverse event. RESULTS AUC statistics (range, 0.52-0.64) showed log(CrClJelliffe) was not a good predictor of grade ≥3 adverse events (anemia, thrombocytopenia, febrile neutropenia, auditory, renal, metabolic, neurologic). Of 3830 patients, 628 (16%) had CrCl <60 mL/min. Positive predictive values for adverse events ranged from 1.8%-15%. Using the Cockcroft-Gault, Cockcroft-Gault with NCCN modifications, and MDRD (instead of Jelliffe) formulas to estimate renal function resulted in a >10% decrease in carboplatin dosing in 16%, 32%, and 5.2% of patients, respectively, and a >10% increase in carboplatin dosing in 41%, 9.6% and 12% of patients, respectively. CONCLUSION The formula used to estimate CrCl affects carboplatin dosing. Estimated CrCl <60 mL/min (by Jelliffe) did not accurately predict adverse events. Efforts continue to better predict renal function. Endorsing National Cancer Institute initiatives to broaden study eligibility, our data do not support a minimum threshold CrCl <60 mL/min as an exclusion criterion from clinical trials.
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Affiliation(s)
- Aaron M Praiss
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - Austin Miller
- NRG Oncology Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY, United States of America.
| | - Judith Smith
- McGovern Medical School, The University of Texas Health Science Center, Houston, TX, United States of America.
| | - Stuart M Lichtman
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America.
| | - Michael Bookman
- Department of Medical Oncology, Kaiser-Permanente Northern California, San Francisco, CA, United States of America.
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America.
| | - Paul Sabbatini
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America.
| | - Floor Backes
- Department of Oncology, James Cancer Center, Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America.
| | - David E Cohn
- Department of Oncology, James Cancer Center, Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America.
| | - Peter Argenta
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America.
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital and Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia.
| | - Michael J Goodheart
- Gynecologic Oncology, University of Iowa Hospitals, Iowa City, IA, United States of America.
| | - David G Mutch
- Gynecologic Oncology, Washington University, St. Louis, MO, United States of America.
| | - David M Gershenson
- Gynecologic Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Krishnansu S Tewari
- Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA.
| | - Robert M Wenham
- Gynecologic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America.
| | | | - Roger B Lee
- Gynecologic Oncology, Tacoma General Hospital, Tacoma, WA, United States of America
| | - Heidi Gray
- Gynecologic Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America.
| | - Angeles Alvarez Secord
- Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America.
| | - Linda Van Le
- Gynecologic Oncology, University of North Carolina, United States of America.
| | - Roisin E O'Cearbhaill
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America.
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Russo C, Mislang AR, Ferraioli D, Soto-Perez-de-Celis E, Colloca G, Williams GR, O'Hanlon S, Cooper L, O'Donovan A, Audisio RA, Cheung KL, Sarrió RG, Stauder R, Jaklitsch M, Cairo C, Gil LA, Sattar S, Kantilal K, Loh KP, Lichtman SM, Brain E, Kanesvaran R, Battisti NML. SIOG COVID-19 Working Group recommendations on COVID-19 therapeutic approaches in older adults with cancer. J Geriatr Oncol 2023; 14:101564. [PMID: 37393123 PMCID: PMC10288307 DOI: 10.1016/j.jgo.2023.101564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/23/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Chiara Russo
- Department of Medical Oncology, Léon Bérard, Comprehensive Cancer Centre, Lyon, France.
| | - Anna Rachelle Mislang
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia.
| | - Domenico Ferraioli
- Department of Gynaecology, Léon Bérard, Comprehensive Cancer Centre, Lyon, France.
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Giuseppe Colloca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - Shane O'Hanlon
- University College Dublin, St Vincent's University Hospital, Dublin, Ireland.
| | - Lisa Cooper
- Department of Geriatric Medicine, Rabin Medical Center, Sackler Faculty of Medicine, Division of Aging, Department of Medicine, Tel Aviv University, Israel.
| | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), Trinity St James's Cancer Institute, Trinity College, Dublin, Ireland.
| | - Riccardo A Audisio
- Department of Surgery, Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden.
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.
| | - Regina Gironés Sarrió
- Department of Medical Oncology, Hospital Universitari i Politècnic La FE, Valencia, Spain.
| | - Reinhard Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria.
| | - Michael Jaklitsch
- Brigham and Women's Hospital - Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Clarito Cairo
- National Integrated Cancer Control Program, Department of Health, Manila, Philippines.
| | - Luiz Antonio Gil
- Geriatric Center for Advanced Medicine - Hospital Sirio-Libanês, São Paulo, SP, Brazil.
| | - Schroder Sattar
- College of Nursing - University of Saskatchewan, Saskatoon, Canada.
| | - Kumud Kantilal
- School of Pharmacy, University of East Anglia, Norwich, UK.
| | - Kah Poh Loh
- University of Rochester Medical Center, Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, Rochester, NY, USA.
| | - Stuart M Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Etienne Brain
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
| | | | - Nicolò Matteo Luca Battisti
- Breast Unit - Department of Medicine Department, The Royal Marsden NHS Foundation Trus, Breast Cancer Research Division, The Institute of Cancer Research, London, UK.
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Sia TY, Tew WP, Purdy C, Chi DS, Menzin AW, Lovecchio JL, Bookman MA, Cohn DE, Teoh DG, Friedlander M, Bender D, Mutch DG, Gershenson DM, Tewari KS, Wenham RM, Wahner Hendrickson AE, Lee RB, Gray HJ, Secord AA, Van Le L, Lichtman SM. The effect of older age on treatment outcomes in women with advanced ovarian cancer receiving chemotherapy: An NRG-Oncology/Gynecologic Oncology Group (GOG-0182-ICON5) ancillary study. Gynecol Oncol 2023; 173:130-137. [PMID: 37148580 PMCID: PMC10414765 DOI: 10.1016/j.ygyno.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/12/2023] [Accepted: 03/23/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To assess the effect of age on overall survival (OS) in women with ovarian cancer receiving chemotherapy. Secondary objectives were to describe the effect of age on treatment compliance, toxicities, progression free survival (PFS), time from surgery to chemotherapy, and rates of optimal cytoreduction. METHODS Women enrolled in GOG 0182-ICON5 with stage III or IV epithelial ovarian cancer (EOC) who underwent surgery and chemotherapy between 2001 and 2004 were included. Patients were divided into ages <70 and ≥ 70 years. Baseline characteristics, treatment compliance, toxicities, and clinical outcomes were compared. RESULTS We included a total of 3686 patients, with 620 patients (16.8%) ≥ 70 years. OS was 37.2 months in older compared to 45.0 months in younger patients (HR 1.21, 95% CI, 1.09-1.34, p < 0.001). Older patients had an increased risk of cancer-specific-death (HR 1.16, 95% CI, 1.04-1.29) as well as non-cancer related deaths (HR 2.78, 95% CI, 2.00-3.87). Median PFS was 15.1 months in older compared to 16.0 months in younger patients (HR 1.10, 95% CI, 1.00-1.20, p = 0.056). In the carboplatin/paclitaxel arm, older patients were just as likely to complete therapy and more likely to develop grade ≥ 2 peripheral neuropathy (35.7 vs 19.7%, p < 0.001). Risk of other toxicities remained equal between groups. CONCLUSIONS In women with advanced EOC receiving chemotherapy, age ≥ 70 was associated with shorter OS and cancer specific survival. Older patients receiving carboplatin and paclitaxel reported higher rates of grade ≥ 2 neuropathy but were not more likely to suffer from other chemotherapy related toxicities. Clintrials.gov: NCT00011986.
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Affiliation(s)
- Tiffany Y Sia
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - William P Tew
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - Christopher Purdy
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Dennis S Chi
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - Andrew W Menzin
- North Shore-Long Island Jewish Medical Center, Manhasset, NY, United States of America.
| | - John L Lovecchio
- North Shore-Long Island Jewish Medical Center, Manhasset, NY, United States of America.
| | - Michael A Bookman
- Gynecologic Oncology Therapeutics, Kaiser Permanente, San Francisco, CA, United States of America.
| | - David E Cohn
- Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America.
| | - Deanna G Teoh
- University of Minnesota Medical Center, Minneapolis, MN, United States of America.
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital and Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia.
| | - David Bender
- University of Iowa Hospitals, Iowa City, IA, United States of America.
| | - David G Mutch
- Washington University, St. Louis, MO, United States of America.
| | | | | | - Robert M Wenham
- Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America.
| | | | - Roger B Lee
- Tacoma General Hospital, Tacoma, WA, United States of America.
| | - Heidi J Gray
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America.
| | | | - Linda Van Le
- University of North Carolina, Chapel Hill, NC, United States of America.
| | - Stuart M Lichtman
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
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Lichtman SM. Missed Opportunities in Geriatric Oncology Research. Oncologist 2023; 28:373-375. [PMID: 36940296 PMCID: PMC10166148 DOI: 10.1093/oncolo/oyad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/22/2023] Open
Abstract
The field of geriatric oncology has made significant progress in recent decades, but there are still missed opportunities in important areas of research. One issue is the underrepresentation of older patients, especially those aged 75 years and older, in clinical trials. This has resulted in a lack of high-quality data for the care of this population, and the American Society of Clinical Oncology has called for an increase in the evidence base for older patients with cancer. The second missed opportunity is the chance to gather important knowledge from older patients participating in clinical trials, such as medications, social support, insurance, and financial information. These data can be easily collected and incorporated into the trial design to enhance the information available to researchers and clinicians. The third missed opportunity is the chance to robustly analyze and report clinical trial data for the benefit of geriatric oncology research. Many trials only report a median age and range, which is a disservice to both the participants and the patients who will be treated based on the study results. To advance geriatric oncology research, the necessary data need to be collected, analyzed, and reported through appropriate representation of older patients, collection of essential information, and thorough analysis and communication of results. Clinical trial design needs to include geriatric baseline parameters, and Cancer Therapy Evaluation Program (CTEP) has modified its template to include these parameters.
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Affiliation(s)
- Stuart M Lichtman
- Wilmot Cancer Institute Geriatric Oncology Research Group, University of Rochester, Rochester, NY, USA
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Ho F, Kow A, Lim WC, Chen MZ, Mohd Rais NC, Ling NMW, Ooi M, Ng JY, Ng YS, Chun M, Yao Y, Mohd Said N, Eng WN, Chen WM, Luah V, Loy Y, Ong J, Wong WY, Korc-Grodzicki B, Lichtman SM, Pang A. Feasibility of a Geriatric Oncology Longitudinal End to End (GOLDEN) Program in a Tertiary Cancer Center in Singapore. Oncologist 2023; 28:e198-e204. [PMID: 36779537 PMCID: PMC10078895 DOI: 10.1093/oncolo/oyac276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/13/2022] [Indexed: 02/14/2023] Open
Abstract
INTRODUCTION In the National University Cancer Institute, Singapore (NCIS), 2 pilot programs providing (i) surgical prehabilitation before cancer surgery and (ii) geriatric oncology support for older adults planned for chemotherapy and/or radiotherapy were merged to form the Geriatric Oncology Longitudinal End to eNd (GOLDEN) program in 2019 to support patients from the time of their cancer diagnosis, through their treatment process, to cancer survivorship. METHODS AND MATERIALS Older adults aged ≥65 years were enrolled in either surgical prehabilitation, the geriatric medical oncology (GO) arm, or both. All patients undergo a geriatric assessment. We assessed if patients had a change in treatment plans based on GOLDEN recommendations, and the impact on patient related outcomes. RESULTS There were 777 patients enrolled in the GOLDEN program over 2 years; 569 (73%) were enrolled in surgical prehabilitation, 308 (40%) were enrolled in the GO arm, with 100 (12.8%) enrolled in both. 56.9% were females. Median age was 73. Lower gastrointestinal (51.2%) and hepatobiliary cancers (24.1%) were the most common cancer types. 43.4% were pre-frail and 11.7% were frail. Of the 308 patients in the GO arm, 86.0% had geriatric syndromes, while 60.7% had a change in their treatment plans based on GOLDEN recommendations. 31.5% reported an improved global health status, while 38.3% maintained their global health status. 226 (73%) responded that they had benefited from the GOLDEN. CONCLUSION More than half of the population was either pre-frail or frail. Amongst those in the GO arm, the majority had geriatric syndromes and had a change in their treatment plans based on GOLDEN recommendations. Majority reported either improvement or maintenance in global health status, with most feeling they have benefited from the program. Further evaluation of the longitudinal geriatric hematology-oncology program for cancer-related outcomes and sustainability should be carried out.
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Affiliation(s)
- Francis Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Alfred Kow
- Department of Surgery, National University Hospital, Singapore
| | - Wan Chin Lim
- Department of Surgery, National University Hospital, Singapore
| | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore
| | - Nydia Camelia Mohd Rais
- Division of Geriatric Medicine, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Natalie Mun Wai Ling
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore
| | - Melissa Ooi
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Jing Yu Ng
- Department of Surgery, Ng Teng Fong General Hospital, Singapore
| | - Yean Shin Ng
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Meiling Chun
- Department of Surgery, Ng Teng Fong General Hospital, Singapore
| | - Yao Yao
- Department of Pharmacy, National University Hospital, Singapore
| | - Noorhanah Mohd Said
- Department of Oncology Nursing, National University Cancer Institute, Singapore
| | - Wan Nghee Eng
- Department of Oncology Nursing, National University Cancer Institute, Singapore
| | - Wen Meei Chen
- Department of Nursing, Ng Teng Fong General Hospital, Singapore
| | - Vivian Luah
- Department of Medical Social Work, National University Hospital, Singapore
| | - Yijun Loy
- Department of Rehabilitation, National University Hospital, Singapore
| | - Jiexin Ong
- Department of Rehabilitation, National University Hospital, Singapore
| | - Wei Yee Wong
- Department of Dietetics, National University Hospital, Singapore
| | | | | | - Angela Pang
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
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7
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Williams GR, Outlaw D, Harvey RD, Lichtman SM, Zamboni WC, Giri S. Chemotherapy dosing in older adults with cancer: One size does NOT fit all. J Geriatr Oncol 2023; 14:101363. [PMID: 36030172 DOI: 10.1016/j.jgo.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/01/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Grant R Williams
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Darryl Outlaw
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - R Donald Harvey
- Winship Cancer Institute, Emory University, Atlanta, GA, United States of America
| | - Stuart M Lichtman
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - William C Zamboni
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Smith Giri
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
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8
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Battisti NML, De Glas N, Soto-Perez-de-Celis E, Liposits G, Bringuier M, Walko C, Lichtman SM, Aapro M, Cheung KL, Biganzoli L, Ring A, Portielje J, Wildiers H, Brain E. Chemotherapy and gene expression profiling in older early luminal breast cancer patients: An International Society of Geriatric Oncology systematic review. Eur J Cancer 2022; 172:158-170. [PMID: 35777273 PMCID: PMC10861271 DOI: 10.1016/j.ejca.2022.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/14/2022] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The benefit of chemotherapy for older patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer (EBC) is a key area of debate. Gene expression profiling (GEP) may identify patients deriving benefit, but their predictive role has not been established for older adults. We summarise evidence on efficacy, safety, and quality-of-life impacts of chemotherapy and on GEP use and impact in older HR-positive, HER2-negative EBC patients. METHODS We conducted a literature search of PubMed and Embase on publications describing prospective studies evaluating chemotherapy in older adults with HR-positive, HER2-negative EBC and on publications describing retrospective and prospective studies evaluating GEP in older adults. RESULTS Eight publications on chemotherapy use, including 2,035 older patients with EBC were selected. Only one trial evaluated chemotherapy survival benefits in older adults, showing no benefit. Of four studies comparing different regimens, only one showed the superiority of taxanes versus anthracyclines alone. Those investigating alternative regimens did not show improvements over standard regimens despite significant limitations. Five publications on GEP, including 445,323 older patients, were included and investigated Oncotype DX. Limited evidence shows that GEP aids treatment decisions in this population. GEP was offered less frequently to older versus younger patients. Higher Recurrence Score was prognostic for distant recurrence, but chemotherapy did not improve prognosis. CONCLUSIONS In older patients with HR-positive, HER2-negative, chemotherapy survival benefits EBC are unclear and GEP is less used. Although its prognostic role is well established, its predictive role remains unknown.
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Affiliation(s)
- Nicolò Matteo Luca Battisti
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Breast Cancer Research Division, The Institute of Cancer Research, London, United Kingdom.
| | - Nienke De Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Gabor Liposits
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense, Denmark.
| | - Michael Bringuier
- Interdisciplinary Supportive Care Department for Cancer Patients and Medical Oncology Department, Institut Curie/Saint-Cloud, Paris, France.
| | - Christine Walko
- Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL, USA.
| | - Stuart M Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Matti Aapro
- Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland.
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.
| | - Laura Biganzoli
- "Sandro Pitigliani" Department of Medical Oncology, Nuovo Ospedale di Prato, Prato, Italy.
| | - Alistair Ring
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Breast Cancer Research Division, The Institute of Cancer Research, London, United Kingdom.
| | - Johanneke Portielje
- Department of Internal Medicine and Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium.
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Paris, France.
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9
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Goldberg RM, Adams R, Buyse M, Eng C, Grothey A, André T, Sobrero AF, Lichtman SM, Benson AB, Punt CJA, Maughan T, Burzykowski T, Sommeijer D, Saad ED, Shi Q, Coart E, Chibaudel B, Koopman M, Schmoll HJ, Yoshino T, Taieb J, Tebbutt NC, Zalcberg J, Tabernero J, Van Cutsem E, Matheson A, de Gramont A. Clinical Trial Endpoints in Metastatic Cancer: Using Individual Participant Data to Inform Future Trials Methodology. J Natl Cancer Inst 2022; 114:819-828. [PMID: 34865086 PMCID: PMC9194619 DOI: 10.1093/jnci/djab218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/14/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Meta-analysis based on individual participant data (IPD) is a powerful methodology for synthesizing evidence by combining information drawn from multiple trials. Hitherto, its principal application has been in questions of clinical management, but an increasingly important use is in clarifying trials methodology, for instance in the selection of endpoints, as discussed in this review. In oncology, the Aide et Recherche en Cancérologie Digestive (ARCAD) Metastatic Colorectal Cancer Database is a leader in the use of IPD-based meta-analysis in methodological research. The ARCAD database contains IPD from more than 38 000 patients enrolled in 46 studies and continues to collect phase III trial data. Here, we review the principal findings of the ARCAD project in respect of endpoint selection and examine their implications for cancer trials. Analysis of the database has confirmed that progression-free survival (PFS) is no longer a valid surrogate endpoint predictive of overall survival in the first-line treatment of colorectal cancer. Nonetheless, PFS remains an endpoint of choice for most first-line trials in metastatic colorectal cancer and other solid tumors. Only substantial PFS effects are likely to translate into clinically meaningful benefits, and accordingly, we advocate an oncology research model designed to identify highly effective treatments in carefully defined patient groups. We also review the use of the ARCAD database in assessing clinical response including novel response metrics and prognostic markers. These studies demonstrate the value of IPD as a tool for methodological studies and provide a reference point for the expansion of this approach within clinical cancer research.
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Affiliation(s)
| | | | - Marc Buyse
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
- Hasselt University, Hasselt, Belgium
| | - Cathy Eng
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Axel Grothey
- West Cancer Center and Research Institute, Germantown, TN, USA
| | | | | | | | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | | | - Tim Maughan
- Gray Institute of Radiation Oncology and Biology, University of Oxford, UK
| | - Tomasz Burzykowski
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
- Hasselt University, Hasselt, Belgium
| | - Dirkje Sommeijer
- University of Amsterdam Academic Medical Centre and Flevohospital, Almere, the Netherlands
| | - Everardo D Saad
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
- Dendrix Research, Sao Paulo, Brazil
| | | | - Elisabeth Coart
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | | | | | | | | | - Julien Taieb
- Georges Pompidou European Hospital, Paris, France
| | | | - John Zalcberg
- Monash University, School of Public Health, Australia
| | - Josep Tabernero
- Vall d’Hebron Hospital Campus and Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Aimery de Gramont
- Hôpital Franco-Britannique, Paris, France
- Fondation ARCAD , Paris, France
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10
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Friedman CF, Zhou Q, Iasonos A, Holland A, Ramirez L, Grisham RN, Guo R, Lichtman SM, Kyi C, Makker V, Mueller JJ, O'Cearbhaill RE, Schram AM, Tew WP, Konner JA, Troso-Sandoval TA, Wibmer AG, Aghajanian C, Hensley ML, Zamarin D. Dysfunctional CD8+ T cells in the tumor microenvironment are associated with response to nivolumab in mismatch repair deficient (dMMR) or hypermutated ovarian (OVCA) or endometrial cancer (EC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5583 Background: EC and a subset of OVCA are associated with high rates of dMMR and are responsive to PD-1 blockade. It is unknown what additional biomarkers beyond dMMR may enrich for benefit in these patients (pts). Methods: This was an investigator-initiated, single-arm, phase II study. Eligible pts had recurrent EC or OVCA that met one of the following criteria: 1) dMMR, as determined by immunohistochemical loss of expression of 1+ MMR genes; 2) MSI-H, as determined by next generation sequencing (MSK-IMPACT); or 3) hypermutated, defined as 20+ non-synonymous somatic mutations. Pts received nivo 240mg IV every 2 weeks or 480mg IV every 4 weeks until toxicity or progression. The co-primary endpoints were 1) the progression-free survival (PFS) rate at 24 weeks (PFS24) and 2) the objective response rate (ORR) by RECIST v1.1. The study was designed using Simon’s two-stage design, with a sample size of 40 pts based on a promising ORR of 25% with a type I error rate of 0.025 and a type II error rate of 0.05. Overall survival (OS), PFS and duration of response (DOR) were calculated using the method of Kaplan-Meier. Adverse events (AEs) were graded per CTCAE and tabulated. Biomarker analyses on the available archival tissue were performed using multiplex immunofluorescence (mIF) labeling for CD8, PD-1, TOX, PD-1, PD-L1, and FoxP3. Quantification of immune phenotypes and interaction studies between CD8+ T cells and PD-L1+ cells was performed in HALO. Results: Between 9/2017 and 5/2021, 35 pts were enrolled; the study closed early due to slow accrual. The median duration of follow-up was 33.2 months. The median age was 64 years (range 36-87); 82% of pts were white, 54% had high grade EC, and 65% had confirmed MLH1 hypermethylation. The ORR was 57.1% (97.5% CI 39.4-100%) [37% PR, 20% CR]. The PFS24 was 62.9% and median PFS was 26.7 months (95% CI 4.9-NE). Neither median DOR nor OS was reached. OS at 1 year was 76.4% (95% CI 58.2-87.4%). The ORR in patients with MLH1 hypermethylation was 52%; 4 of 5 patients with confirmed germline MMR alterations had a response by RECIST. AEs were consistent with the reported literature. Notable treatment related AEs included Grade 4 myocarditis with associated grade 4 AV block, grade 2 extraocular paresis, grade 3 Type 1 diabetes mellitus, and grade 3 elevations in AST/ALT. On mIF analysis, PD-L1 expression did not distinguish responders from non-responders, though interaction between CD8+ T cells and PD-L1+ cells was associated with CR/PR. Increase in relative fraction of dysfunctional CD8+ T cells (characterized by CD8+TOX+PD-1+ phenotype) was also associated with CR/PR. Conclusions: Nivo is an effective and tolerable treatment option for patients with MMR-D/MSI-H or hypermutated EC or OVCA. Presence of dysfunctional CD8+ T cells in the tumors was associated with response, while expression of PD-L1 was not predictive. Clinical trial information: NCT03241745.
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Affiliation(s)
- Claire Frances Friedman
- Memorial Sloan Kettering Cancer Center and Weill Medical College at Cornell University, New York, NY
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Aliya Holland
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Rachel N. Grisham
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Robin Guo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Chrisann Kyi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vicky Makker
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - William P. Tew
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | | | | | | | - Martee Leigh Hensley
- Memorial Sloan Kettering Cancer Center and Weil Cornell Medical College, New York, NY
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11
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Sprangers B, Perazella MA, Lichtman SM, Rosner MH, Jhaveri KD. Improving Cancer Care for Patients With CKD: The Need for Changes in Clinical Trials. Kidney Int Rep 2022; 7:1939-1950. [PMID: 36090489 PMCID: PMC9458993 DOI: 10.1016/j.ekir.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/10/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022] Open
Abstract
Chemotherapeutic agents used to treat cancer generally have narrow therapeutic indices along with potentially serious adverse toxicities. Many cancer drugs are at least partially excreted through the kidney and, thus, the availability of accurate data on safe and effective dosing of these drugs in patients with chronic kidney disease (CKD) is essential to guide treatment decisions. Typically, during drug development, initial clinical studies only include patients with normal or only mildly impaired kidney function. In subsequent preregistration studies, a limited number of patients with more severe kidney dysfunction are included. Data obtained from patients with either severe kidney dysfunction (here defined as an estimated glomerular filtration rate [eGFR] < 30 ml/min or stage 4G CKD) or end-stage kidney disease (ESKD) requiring kidney replacement treatment are particularly limited before drug registration and only a minority of new drug applications to the US Food and Drug Administration (FDA) include data from this population. Unfortunately, limited data and/or other safety concerns may result in a manufacturer statement that the drug is contraindicated in patients with advanced kidney disease, which hinders access to potentially beneficial drugs for these patients. This systemic exclusion of patients with CKD from cancer drug trials remains an unsolved problem, which prevents provision of optimal clinical care for these patients, raises questions of inclusion, diversity, and equity. In addition, with the aging of the population, there are increasing numbers of patients with CKD and cancer who face these issues. In this review, we evaluate the scientific basis to exclude patients with CKD from cancer trials and propose a comprehensive strategy to address this problem.
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12
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Kyi C, Rubinstein MM, Shah P, Zhou Q, Iasonos A, Liu Y, Ramirez L, Paroder V, Green A, Friedman CF, Grisham RN, O'Cearbhaill RE, Troso-Sandoval TA, Cohen SM, Lichtman SM, Konner JA, Hensley ML, Zamarin D, Aghajanian C, Makker V. A phase II trial of IDO-inhibitor, BMS-986205 (IDO), and PD-1 inhibitor, nivolumab (NIVO), in recurrent or persistent endometrial cancer (EC; CA017-056). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5589 Background: Indoleamine 2,3-dioxygenase 1 (IDO1) allows tumor escape through kynurenine production, which induces regulatory T cells and suppresses effector T-cell proliferation. NIVO, an anti-PD-1 inhibitor can upregulate IDO1, supporting the rationale for combining NIVO with IDO. We report results of NIVO as monotherapy and in combination with IDO inhibitor BMS-986205 in the treatment of pts with recurrent EC. Methods: In this single-institution, randomized phase 2 study, eligible pts must have received 1-4 prior lines of chemotherapy and have measurable disease by RECIST v 1.1. All EC histologies, including carcinosarcoma, were allowed. Pts with microsatellite insufficient (MSI-H) or mismatch repair (MMR)-deficient tumors were excluded. Pts were randomized to NIVO 480mg IV every 4 weeks (wks) with or without IDO 100mg orally daily. Primary endpoints were Overall Response Rate [ORR = Complete Response (CR) + Partial Response (PR)] by RECIST v 1.1. Secondary objectives were duration of response (DOR), median progression free survival (mPFS), PFS rate at 24 wks (PFS24wks) and safety. Overall survival (OS) was also evaluated. Results: Between 10/2019 and 11/2021, pts were randomized to receive either NIVO (n = 12) or NIVO + IDO (n = 12). Median age was 67 years (range 48-82) and median number of prior lines of therapy was 2 (range 1-3). Histologies included serous (n = 5, 21%), endometrioid (n = 10, 42%), clear cell (n = 1, 4.2%), carcinosarcoma (n = 6, 25%), undifferentiated (n = 1, 4.2%), and mucinous (n = 1, 4.2%). In the NIVO + IDO arm, 1 pt achieved partial response (8.3%, CI: 0.9-100%) with DOR of 17.6 months. In the NIVO arm, no responses were observed. Efficacy outcomes are summarized in the table. Treatment-related adverse events (TRAEs) grade ≥ 3 in the NIVO arm included acute kidney injury (n = 1, 8.3%), hypokalemia (n = 1, 8.3%), and thromboembolic event (n = 1, 8.3%). In the NIVO + IDO arm, TRAEs grade ≥ 3 included fatigue (n = 1, 8.3%), and elevated liver function (n = 1, 8.3%). No TRAEs led to study-drug interruption or dose reductions. Conclusions: NIVO monotherapy and in combination with IDO showed acceptable safety in pts with recurrent EC. NIVO in combination with IDO showed ORR of 8.3%. No responses were observed with NIVO monotherapy. The trial closed to accrual due to lack of observed clinical efficacy. Clinical trial information: NCT04106414. [Table: see text]
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Affiliation(s)
- Chrisann Kyi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Pooja Shah
- Reading Hospital and Medical Center, Reading, PA
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Yue Liu
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Angela Green
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Claire Frances Friedman
- Memorial Sloan Kettering Cancer Center and Weill Medical College at Cornell University, New York, NY
| | - Rachel N. Grisham
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | | | - Seth M. Cohen
- Continuum Cancer Ctr of New York St Lukes Roosevelt Hosp, New York, NY
| | | | | | - Martee Leigh Hensley
- Memorial Sloan Kettering Cancer Center and Weil Cornell Medical College, New York, NY
| | | | | | - Vicky Makker
- Memorial Sloan Kettering Cancer Center, New York, NY
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13
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McCleary NJ, Harmsen WS, Haakenstad E, Cleary JM, Meyerhardt JA, Zalcberg J, Adams R, Grothey A, Sobrero AF, Van Cutsem E, Goldberg RM, Peeters M, Tabernero J, Seymour M, Saltz LB, Giantonio BJ, Arnold D, Rothenberg ML, Koopman M, Schmoll HJ, Pitot HC, Hoff PM, Tebbutt N, Masi G, Souglakos J, Bokemeyer C, Heinemann V, Yoshino T, Chibaudel B, deGramont A, Shi Q, Lichtman SM. Metastatic Colorectal Cancer Outcomes by Age Among ARCAD First- and Second-Line Clinical Trials. JNCI Cancer Spectr 2022; 6:pkac014. [PMID: 35603849 PMCID: PMC8935011 DOI: 10.1093/jncics/pkac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/09/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We evaluated the time to progression (TTP) and survival outcomes of second-line therapy for metastatic colorectal cancer among adults aged 70 years and older compared with younger adults following progression on first-line clinical trials. METHODS Associations between clinical and disease characteristics, time to initial progression, and rate of receipt of second-line therapy were evaluated. TTP and overall survival (OS) were compared between older and younger adults in first- and second-line trials by Cox regression, adjusting for age, sex, Eastern Cooperative Oncology Group Performance Status, number of metastatic sites and presence of metastasis in the lung, liver, or peritoneum. All statistical tests were 2-sided. RESULTS Older adults comprised 16.4% of patients on first-line trials (870 total older adults aged >70 years; 4419 total younger adults aged ≤70 years, on first-line trials). Older adults and those with Eastern Cooperative Oncology Group Performance Status >0 were less likely to receive second-line therapy than younger adults. Odds of receiving second-line therapy decreased by 11% for each additional decade of life in multivariable analysis (odds ratio = 1.11, 95% confidence interval = 1.02 to 1.21, P = .01). Older and younger adults enrolled in second-line trials experienced similar median TTP and median OS (median TTP = 5.1 vs 5.2 months, respectively; median OS = 11.6 vs 12.4 months, respectively). CONCLUSIONS Older adults were less likely to receive second-line therapy for metastatic colorectal cancer, though we did not observe a statistical difference in survival outcomes vs younger adults following second-line therapy. Further study should examine factors affecting decisions to treat older adults with second-line therapy. Inclusion of geriatric assessment may provide better criteria regarding the risks and benefits of second-line therapy.
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Affiliation(s)
- Nadine J McCleary
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - William S Harmsen
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Ellana Haakenstad
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - James M Cleary
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - Axel Grothey
- West Cancer Center and Research Institute, OneOncology, Germantown, TN, USA
| | | | | | - Richard M Goldberg
- West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center, Morgantown, WV, USA
| | - Marc Peeters
- Department of Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Josep Tabernero
- Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Institute of Oncology Barcelona-Quiron, UVic-UCC, Barcelona, Spain
| | - Matt Seymour
- NIHR Clinical Research Network, Leeds, UK
- St. James’s Hospital and University of Leeds, Leeds, UK
| | | | - Bruce J Giantonio
- Perelman School of Medicine Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Dirk Arnold
- Instituto CUF de Oncologia, Lisbon, Portugal
- Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, University of Urtrecht, Utrecht, Netherlands
| | - Hans-Joachim Schmoll
- Klinik fur Innere Med IV, University Clinic Halle (Saale), Halle, Germany
- Martin Luther University, Halle, Germany
| | - Henry C Pitot
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Paulo M Hoff
- Centro de Oncologia de Brasilia do Sirio Libanes-Unidade Lago Sul, Siro Libanes, Brazil
- Universidade de São Paulo Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Niall Tebbutt
- University of Sydney Medical School, Sydney, Australia
- Austin Health, Heidelberg, Victoria, Australia
| | - Gianluca Masi
- Department of Oncology, University of Pisa, Pisa, Italy
| | - John Souglakos
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece
| | | | - Volker Heinemann
- Department of Hematology/Oncology, Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Germany
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Institut Franco-Britannique, Levallois-Perret, France
| | - Aimery deGramont
- Department of Medical Oncology, Institut Franco-Britannique, Levallois-Perret, France
| | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
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14
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Flynn JR, Bartlett EK, Lichtman SM, Panageas KS. Employing competing risks analysis in an aging population where many patients die from other causes. J Geriatr Oncol 2022; 13:245-248. [PMID: 34521610 PMCID: PMC8882124 DOI: 10.1016/j.jgo.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/09/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Jessica R. Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edmund K. Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stuart M. Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine S. Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Li D, Sun CL, Allen R, Crook CJ, Levi A, Ballena R, Klepin HD, Elias R, Mohile SG, Tew WP, Owusu C, Muss HB, Lichtman SM, Gross CP, Chapman AE, Gajra A, Cohen HJ, Katheria V, Hurria A, Dale W. Risk Factors for Hospitalizations Among Older Adults with Gastrointestinal Cancers. Oncologist 2022; 27:e37-e44. [PMID: 35305099 PMCID: PMC8842372 DOI: 10.1093/oncolo/oyab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background Older adults (≥65 years) with gastrointestinal (GI) cancers who receive chemotherapy are at increased risk of hospitalization caused by treatment-related toxicity. Geriatric assessment (GA) has been previously shown to predict risk of toxicity in older adults undergoing chemotherapy. However, studies incorporating the GA specifically in older adults with GI cancers have been limited. This study sought to identify GA-based risk factors for chemotherapy toxicity–related hospitalization among older adults with GI cancers. Patients and Methods We performed a secondary post hoc subgroup analysis of two prospective studies used to develop and validate a GA-based chemotherapy toxicity score. The incidence of unplanned hospitalizations during the course of chemotherapy treatment was determined. Results This analysis included 199 patients aged ≥65 years with a diagnosis of GI cancer (85 colorectal, 51 gastric/esophageal, and 63 pancreatic/hepatobiliary). Sixty-five (32.7%) patients had ≥1 hospitalization. Univariate analysis identified sex (female), cardiac comorbidity, stage IV disease, low serum albumin, cancer type (gastric/esophageal), hearing deficits, and polypharmacy as risk factors for hospitalization. Multivariable analyses found that patients who had cardiac comorbidity (OR 2.48, 95% CI 1.13-5.42) were significantly more likely to be hospitalized. Conclusion Cardiac comorbidity may be a risk factor for hospitalization in older adults with GI cancers receiving chemotherapy. Further studies with larger sample sizes are warranted to examine the relationship between GA measures and hospitalization in this vulnerable population.
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Affiliation(s)
- Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Can-Lan Sun
- Patient and Family Resource Center, City of Hope, Duarte, CA, USA
| | - Rebecca Allen
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Christiana J Crook
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Abrahm Levi
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Richard Ballena
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Heidi D Klepin
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Rawad Elias
- Department of Medical Oncology, Hartford Healthcare Cancer Institute, Hartford, CT, USA
| | - Supriya G Mohile
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - William P Tew
- Department of Gynecologic Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cynthia Owusu
- Department of Medicine, School of Medicine, Case Western University School of Medicine, Cleveland, OH, USA
| | - Hyman B Muss
- Geriatric Oncology Program, Division of Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stuart M Lichtman
- Department of Gynecologic Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cary P Gross
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Andrew E Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA, USA
| | - Ajeet Gajra
- Cardinal Health, Dublin, OH, USA
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope, Duarte, CA, USA
| | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - William Dale
- Department of Supportive Care, City of Hope, Duarte, CA, USA
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16
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Manning-Geist BL, Gordhandas SB, Giri DD, Iasonos A, Zhou Q, Girshman J, O'Cearbhaill RE, Zamarin D, Lichtman SM, Sabbatini PJ, Tew WP, Li K, McDonnell AS, Aviki EM, Chi DS, Aghajanian CA, Grisham RN. Phase II study of enzalutamide in androgen receptor positive, recurrent, high- and low-grade serous ovarian cancer. Gynecol Oncol 2022; 164:12-17. [PMID: 34763937 PMCID: PMC9449573 DOI: 10.1016/j.ygyno.2021.10.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We sought to determine the safety and efficacy of the oral androgen receptor antagonist enzalutamide in patients with previously treated, recurrent, AR-positive (AR+) ovarian cancer. METHODS This was a single-institution phase II study of patients with AR+ ovarian cancer with measurable disease with 1-3 prior lines of chemotherapy; patients were screened for enrollment from 11/2013-7/2018. Following consent, archival tissue was evaluated for AR+. Enrolled patients received daily enzalutamide 160 mg until progression of disease or treatment discontinuation. Adverse events were graded by CTCAE v4.0. Co-primary endpoints were 6-month progression-free survival (PFS6) and overall response rate (ORR) by RECIST 1.1 criteria. RESULTS During the study period, 160 patients were screened and 59 (45 high-grade serous [HGS] and 14 low-grade serous [LGS]) consented to treatment on study. There was 1 confirmed and 1 unconfirmed partial response. The ORR was 1.7% (90% CI: 0.2-100%). The overall PFS6 rate (as binary) was 22% (90% CI: 15.1-100%). The 6-month PFS rate (as time to event) was 19.8% for HGS patients (90% CI: 12.7-100%) and 38.5% (90% CI: 21.7%-100%) for LGS patients. Grade 3 toxicities occurred in 6 patients (one toxicity (Grade 3 rash) was considered a dose-limiting toxicity). One patient died of cardiac arrest after 42 days on treatment of a cardiac arrest not attributed to study drug. CONCLUSIONS The study met its primary endpoint, with a PFS6 rate of 22% (n = 13); however, the overall response rate was low. Enzalutamide was well tolerated and may be a potential treatment option in select patients.
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Affiliation(s)
| | | | - Dilip D Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Qin Zhou
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey Girshman
- Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roisin E O'Cearbhaill
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Dmitriy Zamarin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Stuart M Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Paul J Sabbatini
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Karen Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Autumn S McDonnell
- Research and Technology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emeline M Aviki
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Dennis S Chi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Carol A Aghajanian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Rachel N Grisham
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA.
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17
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VanderWalde NA, Dockter T, Wakefield DV, Satele D, Sloan J, Jagsi R, Lichtman SM, Freedman RA, Lafky JM, Muss H, Cohen HJ, Le-Rademacher J, Jatoi A. Disparities in older adult accrual to cancer trials: Analysis from the alliance for clinical trials in oncology (A151736). J Geriatr Oncol 2022; 13:20-26. [PMID: 34364834 PMCID: PMC8688206 DOI: 10.1016/j.jgo.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/11/2021] [Accepted: 07/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Older adults are under-represented in cancer clinical trials. However, it remains unclear which types of trials under-enroll aging patients. We aimed to identify associations between trial characteristics and disparate enrollment of older adults onto trials sponsored by the Alliance for Clinical Trials in Oncology (Alliance). METHODS Actual age ≥ 65 percentage and trial data were extracted from the Alliance closed study list. Each trial, based on its cancer type and years of enrollment, was assigned an expected age ≥ 65 percentage extracted from the Surveillance, Epidemiology, and End Results (SEER) US population-based database. Enrollment disparity difference (EDD), the difference between the expected age ≥ 65 percentage and the actual age ≥ 65 percentage, was calculated for each trial. Linear regression determined trial variables associated with larger EDDs and variables with an overall association p-value <0.20 were included in a multivariable fixed-effects linear model. RESULTS The median age of 66,708 patients across 237 trials was 60 years (range 18-102). The average actual age ≥ 65 percentage enrolled per trial was lower than each trial's expected age ≥ 65 percentage average (39% vs. 58%; EDD 19, 95% CI 17.1-21.3%, p < 0.0001). In multivariable analyses, non-genitourinary (GU) cancer types (p < 0.001), trimodality+ trials (estimate 8.78, 95%CI 2.21-15.34, p = 0.009), and phase 2 trials (estimate 4.43 95% CI -0.06-8.91; p = 0.05) were all associated with larger EDDs. CONCLUSIONS Disparate enrollment of older adults is not equal across cancer trials. Future strategies to improve older adult inclusion should focus on trial types associated with the highest disparate enrollment.
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Affiliation(s)
- Noam A VanderWalde
- West Cancer Center and Research Institute, Memphis, TN, United States of America.
| | - Travis Dockter
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Daniel V Wakefield
- West Cancer Center and Research Institute, Memphis, TN, United States of America
| | - Daniel Satele
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Jeff Sloan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Reshma Jagsi
- University of Michigan, Ann Arbor, MI, United States of America
| | - Stuart M Lichtman
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | | | - Jacqueline M Lafky
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Hyman Muss
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States of America
| | - Jennifer Le-Rademacher
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Aminah Jatoi
- Mayo Clinic, Rochester, MN, United States of America
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18
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VanderWalde N, Moughan J, Lichtman SM, Jagsi R, Ballo M, VanderWalde A, Mohiuddin M, Meropol NJ, Kachnic L, Berger A, Ajani J, Anne R, Hopkins JL, Arora A, Meyer J, Ellsworth SG, Lee RJ, Green N, Crane CH. The association of age with acute toxicities in NRG oncology combined modality lower GI cancer trials. J Geriatr Oncol 2021; 13:294-301. [PMID: 34756496 DOI: 10.1016/j.jgo.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/03/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Expected toxicity from chemoradiation (CRT) is an important factor in treatment decisions but is poorly understood in older adults with lower gastrointestinal (GI) malignancies. Our objective was to compare acute adverse events (AAEs) of older and younger adults with lower GI malignancies treated on NRG studies. METHODS Data from 6 NRG trials, testing combined modality therapy in patients with anal or rectal cancer, were used to test the hypothesis that older age was associated with increased AAEs. AAEs and compliance with protocol-directed therapy were compared between patients aged ≥70 and < 70. Categorical variables were compared across age groups using the chi-square test. The association of age on AAEs was evaluated using a covariate-adjusted logistic regression model, with odds ratio (OR) reported. To adjust for multiple comparisons, a p-value <0.01 was considered statistically significant. RESULTS There were 2525 patients, including 380 patients ≥70 years old (15%) evaluable. Older patients were more likely to have worse baseline performance status (PS 1 or 2) (23% vs. 16%, p = 0.001), but otherwise baseline characteristics were similar. Older patients were less likely to complete their chemotherapy (78% vs. 87%, p < 0.001), but had similar RT duration. On univariate analysis, older patients were more likely to experience grade ≥ 3 GI AAEs (36% vs. 23%, p < 0.001), and less likely to experience grade ≥ 3 skin AAEs (8% vs. 14%, p = 0.002). On multivariable analysis, older age was associated with grade ≥ 3 GI AAE (OR 1.93, 95% CI: 1.52, 2.47, p < 0.001) after adjusting for sex, race, PS, and disease site. CONCLUSIONS Older patients with lower GI cancers who underwent CRT were less likely to complete chemotherapy and had higher rates of grade 3+ GI AAEs. These results can be used to counsel older adults prior to treatment and manage expected toxicities throughout pelvic CRT.
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Affiliation(s)
- Noam VanderWalde
- University of Tennessee Health Science Center/The West Clinic - Wolf River, USA.
| | | | | | | | - Matthew Ballo
- University of Tennessee Health Science Center/The West Clinic - Wolf River, USA
| | - Ari VanderWalde
- University of Tennessee Health Science Center/The West Clinic - Wolf River, USA
| | | | - Neal J Meropol
- Flatiron Health/Case Comprehensive Cancer Center, Case Western Reserve University, USA
| | - Lisa Kachnic
- Columbia University, Herbert Irving Comprehensive Cancer Center, USA
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19
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Plotkin E, Dale W, Loh KP, Dotan E, Burhenn P, Presley CJ, Nightingale G, Oyer RA, Ginex P, Karuturi MS, Lichtman SM, Boehmer L. Use of the Delphi method to develop a guideline-based geriatric oncology gap assessment. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
236 Background: Older adults are more likely to be diagnosed with cancer than their younger counterparts. Because the underlying health status of older adults with cancer is generally heterogeneous, geriatric assessment (GA) is helpful for uncovering age-related vulnerabilities and guiding subsequent care planning. GA provides multidimensional, multidisciplinary evaluations of pertinent health domains. When used to evaluate an older adult with cancer prior to initiating therapy, GA and screening tools can help oncologists differentiate between fit and frail patients and tailor their treatment accordingly. Methods: The Association of Community Cancer Centers (ACCC) conducted a 4-round Delphi method to achieve expert consensus (≥75%) related to 9 domains of geriatric oncology care from a multidisciplinary perspective. A survey was conducted with 70 international clinicians working in geriatric oncology to assess perspectives on guideline-recommended GA tools in clinical practice. Facilitator led focus groups were conducted to review the results in a large group format and come to consensus. Aggregated results were shared back with the group to ensure effective capture of group discussion regarding validated clinical practice tools to include as resources in the gap assessment instrument. Results: A 32 question geriatric oncology gap assessment was developed in an online survey platform. This tool was beta tested by 30 individuals at cancer programs of various types and regions across the US. A final version was published and made accessible for multidisciplinary teams to self-assess care delivery for older adults with cancer in 9 domains: Functional Status; Cognition; Comorbidities; Decision Making: Screening, Life Expectancy, Chemo Toxicity; Pharmacy/Medication Management; Psychological Health; Nutrition; Patient Goals and Needs; and Communication and Workforce Training. Within each domain, respondents select the level (see Table) that most closely represents the practice(s) at their institution. A personalized report is generated. Sample Question. Conclusions: The ACCC geriatric oncology gap assessment offers cancer programs a validated way to evaluate care delivery for older adults with cancer. To optimize workflow, cancer programs should consider utilizing gap assessment results to develop and advance scalable quality improvement programs at their institution, taking into consideration resource level and infrastructure.[Table: see text]
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Affiliation(s)
- Elana Plotkin
- Association of Community Cancer Centers, Rockville, MD
| | - William Dale
- City of Hope National Medical Center, Duarte, CA
| | - Kah Poh Loh
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | - Ginah Nightingale
- Thomas Jefferson University, Jefferson College of Pharmacy, Philadelphia, PA
| | - Randall A. Oyer
- Ann B. Barshinger Cancer Institute, Penn Medicine at Lancaster General Health, Lancaster, PA
| | | | | | | | - Leigh Boehmer
- Association of Community Cancer Centers, Rockville, MD
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20
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Singh JC, Lichtman SM. Targeted Agents for HER2-Positive Breast Cancer: Optimal Use in Older Patients. Drugs Aging 2021; 38:829-844. [PMID: 34423398 DOI: 10.1007/s40266-021-00889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
The human epidermal growth factor-2 (HER2) gene is overexpressed in 15-20 % of all breast cancers. HER2 overexpression is a predictive factor in breast cancer and is associated with high rates of disease recurrence and death in the absence of adjuvant systemic therapy. With the advent of HER2-directed therapies, there has been a significant improvement in the outcome of HER2-positive (HER2+) breast cancer in all clinical settings. Patients aged > 65 years remain under-represented in most clinical trials. Existing literature suggests that older patients with HER2+ disease derive a similar benefit from anti-HER2 therapies as do their younger counterparts, in both adjuvant and metastatic settings. Cardiotoxicity from HER2-directed therapy is a major concern with older patients, especially in the setting of pre-existing co-morbidities. Older patients need a geriatric assessment before beginning any systemic therapy, to identify patients predisposed to developing toxicity and to plan therapy. Many onco-geriatric tools have been developed to further identify frail patients. In this article, we discuss the most up-to-date clinical data on existing therapies for HER2+ breast cancer in adjuvant, neoadjuvant, and metastatic settings, and their application in older patients. We attempt to highlight clinical benefits and toxicities in this group that may aid clinicians in therapeutic decision making.
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Affiliation(s)
| | - Stuart M Lichtman
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, USA
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21
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Zivanovic O, Chi DS, Zhou Q, Iasonos A, Konner JA, Makker V, Grisham RN, Brown AK, Nerenstone S, Diaz JP, Schroeder ED, Langstraat CL, Paroder V, Lakhman Y, Soldan K, Su K, Gardner GJ, Andikyan V, Guo J, Jewell EL, Long Roche K, Troso-Sandoval T, Lichtman SM, Moukarzel LA, Dessources K, Abu-Rustum NR, Aghajanian C, Tew WP, Beumer J, Sonoda Y, O'Cearbhaill RE. Secondary Cytoreduction and Carboplatin Hyperthermic Intraperitoneal Chemotherapy for Platinum-Sensitive Recurrent Ovarian Cancer: An MSK Team Ovary Phase II Study. J Clin Oncol 2021; 39:2594-2604. [PMID: 34019431 PMCID: PMC8330970 DOI: 10.1200/jco.21.00605] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The purpose of this phase II study was to evaluate hyperthermic intraperitoneal chemotherapy (HIPEC) with carboplatin for recurrent ovarian cancer during secondary cytoreductive surgery. MATERIALS AND METHODS Patients were intraoperatively randomly assigned to carboplatin HIPEC (800 mg/m2 for 90 minutes) or no HIPEC, followed by five or six cycles of postoperative IV carboplatin-based chemotherapy, respectively. Based on a binomial single-stage pick-the-winner design, an arm was considered winner if ≥ 17 of 49 patients were without disease progression at 24 months post-surgery. Secondary objectives included postoperative toxicity and HIPEC pharmacokinetics. RESULTS Of 98 patients, 49 (50%) received HIPEC. Complete gross resection was achieved in 82% of the HIPEC patients and 94% of the standard-arm patients. Bowel resection was performed in 37% of patients in the HIPEC arm compared with 65% in the standard (P = .008). There was no perioperative mortality and no difference in use of ostomies, length of stay, or postoperative toxicity. At 24 months, eight patients (16.3%; 1-sided 90% CI, 9.7 to 100) were without progression or death in the HIPEC arm and 12 (24.5%; 1-sided 90% CI, 16.5 to 100) in the standard arm. With a medium follow-up of 39.5 months, 82 patients progressed and 37 died. The median progression-free survival in the HIPEC and standard arms were 12.3 and 15.7 months, respectively (hazard ratio, 1.54; 95% CI, 1 to 2.37; P = .05). There was no significant difference in median overall survival (52.5 v 59.7 months, respectively; hazard ratio, 1.39; 95% CI, 0.73 to 2.67; P = .31). These analyses were exploratory. CONCLUSION HIPEC with carboplatin was well tolerated but did not result in superior clinical outcomes. This study does not support the use of HIPEC with carboplatin during secondary cytoreductive surgery for platinum-sensitive recurrent ovarian cancer.
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Affiliation(s)
- Oliver Zivanovic
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Dennis S. Chi
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Qin Zhou
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Alexia Iasonos
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Jason A. Konner
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Vicky Makker
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Rachel N. Grisham
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Amy K. Brown
- Hartford Healthcare Cancer Institute, Hartford, CT
| | | | | | | | | | - Viktoriya Paroder
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Krysten Soldan
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Katy Su
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Ginger J. Gardner
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Vaagn Andikyan
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | - Elizabeth L. Jewell
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Kara Long Roche
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | - Stuart M. Lichtman
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Lea A. Moukarzel
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Kimberly Dessources
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Nadeem R. Abu-Rustum
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - William P. Tew
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Jan Beumer
- UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Yukio Sonoda
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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22
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Lichtman SM, Cohen HJ, Muss H, Tew WP, Korc-Grodzicki B. From Assessment to Implementation and Beyond in Cancer and Aging Research. J Clin Oncol 2021; 39:2217-2225. [PMID: 34043443 PMCID: PMC8260919 DOI: 10.1200/jco.21.00317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Hyman Muss
- Department of Medicine and UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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23
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Bachet JB, Chibaudel B, Rakez M, Goldberg RM, Tebbutt NC, Van Cutsem E, Haller DG, Hecht JRR, Mayer RJ, Lichtman SM, Benson A, Sobrero AF, Tabernero J, Adams R, Zalcberg JR, Grothey A, Yoshino T, Shi Q, De Gramont A. Characteristics of patients (pts) and prognostic factors across treatment lines (TL) in metastatic colorectal cancer (mCRC): An analysis from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3575 Background: Pts with mCRC frequently receive ≥1 sequential treatment TL. Approximately 50%-60% of pts receive second-line (L2) and 20%-30% third-line (L3) regimens in routine practice. We investigated the pts clinical/tumor characteristics and their prognostic impact across TL. Methods: Data from 37,560 pts enrolled in 48 randomized trials (34 in first (L1), 9 in L2, and 5 in L3) were analyzed. Candidate variables (VAR) measured at enrollment were sex, age, body mass index, performance status (PS), bilirubin, hemoglobin (Hb), platelets (Pl), derived white blood cells-to-absolute neutrophil counts ratio (WBC/ANC), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), primary tumor location, and number and location of metastatic sites (MS). Missing data were imputed. VAR with significant value at all TL were selected to construct a prognostic score of overall survival (OS) in training set (TS, n=30,050; 80%). For each TL, the score was calculated as the sum on the estimations of the VAR’ coefficients from the common multivariate model; Cox’s model was used to define risk groups. The discrimination capability was assessed using the Harrell’s C-index. External validation was done in the validation set (VS, n=7,510; 20%). Results: A total of 26,974 pts in L1, 7,693 pts in L2 and 2,893 pts in L3 were analyzed. The following characteristics increased continuously over TL: ≥2 MS (57%, 72%, 82%), lung metastases (50%, 74%, 91%), lymph nodes metastases (51%, 61%, 80%), KRAS mutation (37%, 47%, 51%) and elevated ALP (46%, 52%, 61%). BRAF mutation decreased (9%, 7%, 5%). In L1 vs L3 trials, 70% vs 89% of patients had primary tumor resection, 10% vs 80% had at least one metastasectomy and 31% vs 78% had a late metachronous (>12 months) metastasis. 7 independent VAR were retained in the prognostic score (PS, Hb, Pl, WBC/ANC, LDH, ALP, and the number of MS); four pt groups with significantly different prognoses were defined (table). This score remained valid when excluding pts with PS 2. Third-line oral drugs (vs placebo) and subsequent line (L2/L1 or L3/L2) were effective in all prognostic groups. Conclusions: Clinical/tumor pt characteristics significantly varied over subsequent TL in patients included in randomized trials. The same prognostic model using practical clinical and biological variables can be used in all TL.[Table: see text]
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Affiliation(s)
| | | | - Manel Rakez
- Statistical Unit, ARCAD Foundation, Levallois-Perret, France
| | | | - Niall C. Tebbutt
- Olivia Newton-John Cancer, Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | - Daniel G. Haller
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | - Josep Tabernero
- Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology (VHIO), UVic-UCC, Barcelona, Spain
| | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, United Kingdom
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Magnuson A, Bruinooge SS, Singh H, Wilner KD, Jalal S, Lichtman SM, Kluetz PG, Lyman GH, Klepin HD, Fleury ME, Hirsch B, Melemed A, Arnaldez FI, Basu Roy U, Schenkel C, Sherwood S, Garrett-Mayer E. Modernizing Clinical Trial Eligibility Criteria: Recommendations of the ASCO-Friends of Cancer Research Performance Status Work Group. Clin Cancer Res 2021; 27:2424-2429. [PMID: 33563633 PMCID: PMC8102305 DOI: 10.1158/1078-0432.ccr-20-3868] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/01/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Performance status (PS) is one of the most common eligibility criteria. Many trials are limited to patients with high-functioning PS, resulting in important differences between trial participants and patient populations with the disease. In addition, existing PS measures are subjective and susceptible to investigator bias. EXPERIMENTAL DESIGN A multidisciplinary working group of the American Society of Clinical Oncology and Friends of Cancer Research evaluated how PS eligibility criteria could be more inclusive. The working group recommendations are based on a literature search, review of trials, simulation study, and multistakeholder consensus. The working group prioritized inclusiveness and access to investigational therapies, while balancing patient safety and study integrity. RESULTS Broadening PS eligibility criteria may increase the number of potentially eligible patients for a given clinical trial, thus shortening accrual time. It may also result in greater participant diversity, potentially reduce trial participant and patient disparities, and enable clinicians to more readily translate trial results to patients with low-functioning PS. Potential impact on outcomes was explored through a simulation trial demonstrating that when the number of Eastern Cooperative Oncology Group PS2 participants was relatively small, the effect on the estimated HR and power was modest, even when PS2 patients did not derive a treatment benefit. CONCLUSIONS Expanding PS eligibility criteria to be more inclusive may be justified in many cases and could result in faster accrual rates and more representative trial populations.See related commentary by Giantonio, p. 2369.
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Affiliation(s)
| | | | | | | | - Shadia Jalal
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Heidi D Klepin
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Mark E Fleury
- American Cancer Society Cancer Action Network, Washington, D.C
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25
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Klepin HD, Sun CL, Smith DD, Elias R, Trevino KM, Bryant AL, Li D, Nelson C, Tew WP, Mohile SG, Gajra A, Owusu C, Gross C, Lichtman SM, Katheria VV, Muss HB, Chapman AE, Cohen HJ, Hurria A, Dale W. Predictors of Unplanned Hospitalizations Among Older Adults Receiving Cancer Chemotherapy. JCO Oncol Pract 2021; 17:e740-e752. [PMID: 33881905 PMCID: PMC8258152 DOI: 10.1200/op.20.00681] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Hospitalizations during cancer treatment are costly, can impair quality of life, and negatively affect therapy completion. Our objective was to identify risk factors for unplanned hospitalization among older adults receiving chemotherapy. METHODS This is a secondary analysis of a multisite cohort study (N = 750) of patients ≥ 65 years of age evaluated with a geriatric assessment (GA) to predict chemotherapy toxicity. The primary outcome of this analysis was unplanned hospitalizations during treatment; the secondary outcome was length of stay (LOS) of the first hospitalization. Independent variables included pretreatment GA measures, laboratory values, cancer type and stage, and treatment intensity characteristics. We used logistic regression to estimate the odds of hospitalization and generalized linear models for LOS in multivariable analyses. RESULTS The sample median age was 72 years (range, 65-94 years); 59% had stage IV disease. At least one unplanned hospitalization occurred in 193 patients (25.7%) during receipt of chemotherapy. In multivariable analyses controlling for cancer type, the following baseline characteristics were significantly associated with increased odds of hospitalization: needing help bathing or dressing (odds ratio [OR], 1.8; 95% CI, 1.0 to 3.1), polypharmacy (≥ 5 meds) (OR, 1.6; 95% CI, 1.1 to 2.4), more comorbid conditions (OR, 1.1; 95% CI, 1.0 to 1.3), availability of someone to take them to the doctor (OR, 2.0; 95% CI, 1.0 to 4.1), CrCl < 60 mL/min (OR, 1.7; 95% CI, 1.1 to 2.4), and albumin < 3.5 g/dL (OR, 1.8; 95% CI, 1.2 to 2.8). In multivariable analyses, older age, self-reported presence of liver or kidney disease, living alone and depressive symptoms were associated with longer LOS. CONCLUSION Readily available GA variables and laboratory data, but not age, were associated with unplanned hospitalizations among older adults receiving chemotherapy. If validated, these data can inform prediction models and the design of interventions to decrease unplanned hospitalizations.
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Affiliation(s)
- Heidi D Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Can-Lan Sun
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - David D Smith
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Rawad Elias
- Hartford Healthcare Cancer Institute, Hartford, CT
| | | | - Ashley Leak Bryant
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daneng Li
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | - William P Tew
- Memorial Sloan Kettering Cancer Center, New York City, NY
| | | | | | - Cynthia Owusu
- Case Western University School of Medicine, Cleveland, OH
| | - Cary Gross
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT
| | | | | | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - William Dale
- City of Hope Comprehensive Cancer Center, Duarte, CA
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26
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Freedman RA, Minami CA, Winer EP, Morrow M, Smith AK, Walter LC, Sedrak MS, Gagnon H, Perilla-Glen A, Wildiers H, Wildes TM, Lichtman SM, Loh KP, Brain EGC, Ganschow PS, Hunt KK, Mayer DK, Ruddy KJ, Jagsi R, Lin NU, Canin B, LeStage BK, Revette AC, Schonberg MA, Keating NL. Individualizing Surveillance Mammography for Older Patients After Treatment for Early-Stage Breast Cancer: Multidisciplinary Expert Panel and International Society of Geriatric Oncology Consensus Statement. JAMA Oncol 2021; 7:609-615. [PMID: 33507222 DOI: 10.1001/jamaoncol.2020.7582] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance There is currently no guidance on how to approach surveillance mammography for older breast cancer survivors, particularly when life expectancy is limited. Objective To develop expert consensus guidelines that facilitate tailored decision-making for routine surveillance mammography for breast cancer survivors 75 years or older. Evidence After a literature review of the risk of ipsilateral and contralateral breast cancer events among breast cancer survivors and the harms and benefits associated with mammography, a multidisciplinary expert panel was convened to develop consensus guidelines on surveillance mammography for breast cancer survivors 75 years or older. Using an iterative consensus-based approach, input from clinician focus groups, and critical review by the International Society for Geriatric Oncology, the guidelines were refined and finalized. Findings The literature review established a low risk for ipsilateral and contralateral breast cancer events in most older breast cancer survivors and summarized the benefits and harms associated with mammography. Draft mammography guidelines were iteratively evaluated by the expert panel and clinician focus groups, emphasizing a patient's risk for in-breast cancer events, age, life expectancy, and personal preferences. The final consensus guidelines recommend discontinuation of routine mammography for all breast cancer survivors when life expectancy is less than 5 years, including those with a history of high-risk cancers; consideration to discontinue mammography when life expectancy is 5 to 10 years; and continuation of mammography when life expectancy is more than 10 years. Individualized, shared decision-making is encouraged to optimally tailor recommendations after weighing the benefits and harms associated with surveillance mammography and patient preferences. The panel also recommends ongoing clinical breast examinations and diagnostic mammography to evaluate clinical findings and symptoms, with reassurance for patients that these practices will continue. Conclusions and Relevance It is anticipated that these expert guidelines will enhance clinical practice by providing a framework for individualized discussions, facilitating shared decision-making regarding surveillance mammography for breast cancer survivors 75 years or older.
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Affiliation(s)
- Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Christina A Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eric P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Monica Morrow
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco.,Division of Geriatrics, Veterans Affairs Health Care System, San Francisco, California
| | - Louise C Walter
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco.,Division of Geriatrics, Veterans Affairs Health Care System, San Francisco, California
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Haley Gagnon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Adriana Perilla-Glen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Tanya M Wildes
- Division of Medical Oncology, Washington University School of Medicine, St Louis, Missouri
| | | | - Kah Poh Loh
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Pamela S Ganschow
- Department of Medicine, Rush University Medical College and Cook County Health, Chicago, Illinois
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Deborah K Mayer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill
| | | | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor.,Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Barbara K LeStage
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Alliance for Clinical Trials in Oncology, Boston, Massachusetts
| | - Anna C Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mara A Schonberg
- Division of General Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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27
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Sprangers B, Van der Veen A, Hamaker ME, Rostoft S, Latcha S, Lichtman SM, de Moor B, Wildiers H. Initiation and termination of dialysis in older patients with advanced cancer: providing guidance in a complicated situation. The Lancet Healthy Longevity 2021; 2:e42-e52. [DOI: 10.1016/s2666-7568(20)30060-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/09/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023] Open
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28
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Lichtman SM. Cancer treatment at the end of life in older patients. Ann Transl Med 2020; 8:895. [PMID: 32793739 PMCID: PMC7396764 DOI: 10.21037/atm.2020.03.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/27/2020] [Indexed: 04/29/2024]
Affiliation(s)
- Stuart M Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, NY, USA
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29
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Zivanovic O, Chi D, Zhou Q, Iasonos A, Makker V, Grisham RN, Konner JA, Diaz JP, Brown AK, Langstraat CL, Paroder V, Soldan K, Su K, Gardner GJ, Jewell EL, Long K, Tew WP, Lichtman SM, Sonoda Y, O'Cearbhaill RE. A randomized phase II trial of secondary cytoreductive surgery (SCS) +/- carboplatin hyperthermic intraperitoneal chemotherapy (HIPEC) in patients (pts) with recurrent platinum-sensitive ovarian cancer (EOC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6016 Background: The role of HIPEC for recurrent EOC is not well defined. The aim of this phase II study was to determine the proportion of pts without evidence of disease progression at 24 months post SCS +/- intraoperative carboplatin HIPEC. Methods: After SCS to ≤ 0.5 cm residual visible disease pts were intraoperatively randomized to carboplatin HIPEC (800mg/m2 for 90 minutes) or no HIPEC. The HIPEC arm received 5 additional and the standard arm received 6 postoperative cycles of IV platinum-based chemotherapy without maintenance treatment. Based on an exact binomial single stage “pick the winner” design, each arm is considered “winner” if ≥ 17/49 pts are without evidence of disease progression at 24 months post SCS. Secondary objectives include postoperative grade ≥ 3 toxicity and complications within 4 weeks post SCS, and pharmacokinetics of carboplatin HIPEC. Results: Of 98 pts, 49 (50%) were randomized to the HIPEC arm. The arms were well balanced for age, stage, histology, BRCA mutation status, prior chemotherapy, and disease-free interval. Complete gross SCS was achieved in 94% of the standard and 82% of the HIPEC arm (p = 0.12). Bowel resection was performed more frequently in the standard (65%) compared to the HIPEC arm (37%; p = 0.008). Median operative time was shorter in the standard (296 minutes) compared to the HIPEC arm (475 minutes; p < 0.001). There was no perioperative mortality and no difference in use of ostomies, length of stay or postoperative toxicity. At a median follow-up of 27.7 months (range: 8.8-81.8 months) 70 of 98 pts progressed and 26 died with a median progression free survival (PFS) of 14.3 months (12.1-16 months) and a median overall survival (OS) of 55.2 months (47.7-not reached). At 24 months post SCS 32 pts progressed within 24 months in the standard versus 35 in the HIPEC arm. There was no statistically significant difference in median PFS (15.4 vs 12.3 months, p = 0.173) or median OS (69.2 vs 53.1 months, p = 0.317) between arms. These are preliminary efficacy estimates as 83/98 pts have a minimum of 24 months follow-up. Conclusions: The HIPEC arm did not reach the predefined “winner” endpoint; the standard arm is still undetermined as 6 pts did not reach 24 months follow-up. No perioperative mortality, and no increased perioperative morbidity or toxicity was seen with HIPEC. SCS with carboplatin HIPEC followed by 5 cycles of platinum-based chemotherapy was not superior to SCS without HIPEC followed by 6 cycles of platinum-based chemotherapy. Clinical trial information: NCT01767675.
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Affiliation(s)
- Oliver Zivanovic
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Dennis Chi
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Vicky Makker
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rachel N. Grisham
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Jason A. Konner
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | - Amy K. Brown
- Hartford Hospital Healthcare Centers, Glatsonbury, CT
| | | | | | | | - Katy Su
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ginger J. Gardner
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Elizabeth Lin Jewell
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Kara Long
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - William P. Tew
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | - Yukio Sonoda
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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30
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Lichtman SM. Geriatricizing clinical trials: The legacy of Arti Hurria, MD. J Geriatr Oncol 2020; 11:149-150. [DOI: 10.1016/j.jgo.2019.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
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31
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McCleary NJ, Harmsen WS, VanCutsem E, Sobrero AF, Goldberg RM, Tabernero J, Seymour M, Saltz LB, Giantonio BJ, Dirk A, Rothenberg ML, Koopman M, Schmoll HJHJ, Pitot HC, Hoff PM, Falcone A, De Gramont A, Shi Q, Lichtman SM. Receipt and survival outcomes by age following second-line therapy for metastatic CRC (mCRC): Analysis of 5,289 patients from the ARCAD Clinical Trials Program. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6 Background: Rates and survival outcomes for second-line therapy for mCRC for OA vs. YA are poorly understood. Methods: Pts with available subsequent treatment data after progression from 10 1st line trials were included. Associations between key clinical/disease characteristics, time to initial progression (TTiP) and rate of receipt of second-line therapy were evaluated. Time to progression (TTP) and overall survival (OS) were compared between OA and YA who were enrolled on second-line trials by Cox regression, adjusting for age, sex, ECOG PS, number of metastatic sites, presence of metastasis in lung/liver/peritoneum. Results: OA comprised 16.4% of first-line trials. OA and ECOG PS >0 were less likely to receive second-line therapy than YA. Odds of receiving second-line therapy decreased by 11% for each additional decade of life in multivariate analysis (p=0.0117). OA enrolled in second-line trials experience similar mTTP and mOS as YA (5.1 vs. 5.2mos; 11.6 vs 12.4mos, respectively). Conclusions: OA are less likely to receive 2nd line therapy for mCRC. We did not observe a statistical difference in survival outcomes for OA vs. YA following second-line therapy. Further study is needed to examine unmeasured factors, including comorbidity and functional status given observed inferior outcomes among adults with ECOG PS >0, and consideration given to inclusion of geriatric assessment to select OA likely to benefit from 2nd line therapy for mCRC. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Josep Tabernero
- Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Matt Seymour
- NIHR Clinical Research Network, Leeds UK St James's Hospital, and University of Leeds, Leeds, United Kingdom
| | | | | | - Arnold Dirk
- Instituto CUF de Oncologia, Lisbon, Portugal
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32
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Shahrokni A, Sun CL, Tew WP, Mohile SG, Ma H, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Katheria V, Cohen HJ, Hurria A. The association between social support and chemotherapy-related toxicity in older patients with cancer. J Geriatr Oncol 2019; 11:274-279. [PMID: 31501014 DOI: 10.1016/j.jgo.2019.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/19/2019] [Accepted: 08/28/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The goal of this study was to evaluate the relationship between social support (SS) and grade 3-5 chemotherapy-related toxicities among older adults with cancer. METHODS This is a secondary analysis of a prospective longitudinal study of patients aged 65+ with solid cancer which led to the development of a predictive model for grade 3-5 chemotherapy-related toxicity (the Cancer and Aging Research Group [CARG] Chemotherapy Toxicity Risk Score). SS was measured by a modified version of Medical-Outcome Study-Social Support Survey and grade 3-5 hematological and non-hematological toxicities were captured and graded using CTCAE version 3.0. Patients were categorized into those with poor (SS score ≤ 75) and good SS (score of 76-100). Multivariate polychotomous logistic regression was used to examine the associations between SS and chemotherapy-related toxicity with adjustment for the CARG Toxicity Risk Score. RESULTS Compared to patients with good SS, those with poor SS were less likely to have grade 3-5 toxicity, especially for non-hematological toxicity (adjusted OR = 0.52, p = .02). Patients who did not have someone to take them to the doctor "most" or "all of the time" were less likely to have grade 3-5 non-hematological toxicity compared to patients who had someone to take them to the doctor most or all of the time (adjusted OR = 0.32, p = .02). CONCLUSION Our study showed that patients with poor SS, especially those with less availability of someone to take them to doctors were less likely to have a documented grade 3-5 non-hematological toxicity.
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Affiliation(s)
- Armin Shahrokni
- Department of Medicine, Memorial Sloan Kettering Cancer Center, NY, NY, USA.
| | - Can-Lan Sun
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, USA
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Supriya Gupta Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Huiyan Ma
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Cynthia Owusu
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Heidi D Klepin
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Cary Philip Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stuart M Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Ajeet Gajra
- ICON Clinical Research, North Wales, PA, USA
| | - Vani Katheria
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Harvey Jay Cohen
- Center for the Study of Aging & Human Development, Duke University Medical Center, Durham, NC, USA
| | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
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33
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Adjei A, Buckner JC, Cathcart-Rake E, Chen H, Cohen HJ, Dao D, De Luca JE, Feliciano J, Freedman RA, Goldberg RM, Hopkins J, Hubbard J, Jatoi A, Karuturi M, Kemeny M, Kimmick GG, Klepin HD, Krok-Schoen JL, Lafky JM, Le-Rademacher JG, Li D, Lichtman SM, Maggiore R, Mandelblatt J, Morrison VA, Muss HB, Ojelabi MO, Sedrak MS, Subbiah N, Sun V, Tuttle S, VanderWalde N, Wildes T, Wong ML, Woyach J. Arti Hurria, M.D.: A tribute to her shining legacy in the Alliance for Clinical Trials in Oncology. J Geriatr Oncol 2019; 11:179-183. [PMID: 31201095 DOI: 10.1016/j.jgo.2019.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - Araba Adjei
- Mayo Clinic, Rochester, MN, United States of America
| | - Jan C Buckner
- Mayo Clinic, Rochester, MN, United States of America
| | | | - Hongbin Chen
- Roswell Park Cancer Institute, Buffalo, New York, United States of America
| | - Harvey J Cohen
- Duke Cancer Institute, Durham, NC, United States of America
| | - Dyda Dao
- Mayo Clinic, Rochester, MN, United States of America
| | - Jo-Ellen De Luca
- Alliance for Clinical Trials Patient Advocate, United States of America
| | | | | | - Richard M Goldberg
- West Virginia University, Morgantown, Virginia, United States of America
| | - Judith Hopkins
- Novant Health, Winston-Salem, NC, United States of America
| | | | - Aminah Jatoi
- Mayo Clinic, Rochester, MN, United States of America.
| | - Meghan Karuturi
- M.D. Anderson Cancer Center, Houston, TX, United States of America
| | | | | | - Heidi D Klepin
- Wake Forest University, Winston-Salem, NC, United States of America
| | | | | | | | - Daneng Li
- City of Hope, Duarte, CA, United States of America
| | - Stuart M Lichtman
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Ronald Maggiore
- University of Rochester, Rochester, New York, United States of America
| | | | - Vicki A Morrison
- University of Minnesota, Hennepin County Medical Center, Minneapolis, MN, United States of America
| | - Hyman B Muss
- University of North Carolina, Chapel Hill, NC, United States of America
| | | | | | - Niveditha Subbiah
- Alliance for Clinical Trials, Protocol Operations Office, Chicago, IL, United States of America
| | - Virginia Sun
- City of Hope, Duarte, CA, United States of America
| | - Susan Tuttle
- Southeast Clinical Oncology, Winston-Salem, NC, United States of America
| | | | - Tanya Wildes
- Washington University, St. Louis, MO, United States of America
| | - Melisa L Wong
- University of California at San Francisco, San Francisco, CA, United States of America
| | - Jennifer Woyach
- The Ohio State University, Columbus, Ohio, United States of America
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34
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VanderWalde NA, Wakefield DV, Satele DV, Dockter T, Sloan JA, Jagsi R, Lichtman SM, Freedman RA, Lafky JM, Muss HB, Cohen HJ, Hurria A, Jatoi A, Le-Rademacher J. Modeling accrual of older adults to cancer clinical trials: (Alliance A151736). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18132 Background: Older adults (65+ years) make up > 50% of cancer patients in the US,1 yet, older patient enrollment onto trials remains < 30%.2 This study’s aim was to determine the association between trial level variables and accrual rates of adults 65+ to better design trials that can more improve enrollment of these patients. Methods: We analyzed enrollment percentages of patients age 65+ in non-age specific Alliance trials with > 50 patients, that completed accrual between 1995- 2015. Enrollment percentage by 65+ for each study was compared to cancer incidence percentage by 65+ according to the Surveillance, Epidemiology, and End Results (SEER) Program for the same time periods. Enrollment Disparity Difference (EDD)3, defined as the difference between SEER incidence percentage of patients 65+ and the trial percentage enrollment of 65+ was calculated for each trial ( SEER % – trial %). Univariate analyses (UVA) were performed using simple linear regression to determine trial variables associated with larger EDDs (higher disparity). Variables that had an F-test p-value < 0.20 were included in a multivariable fixed-effects linear model for multivariate analysis (MVA). Results: Median age of 66,708 patients across 237 trials with 10 cancer types was 60 years. Average % of 65+ in trials was lower than average SEER comparison % 65+ per trial (37.6% vs. 57.8%). The median trial EDD, was 16.7%. On UVA, cancer type was significantly associated with higher EDD (see Table). Use of fewer modalities (1, 2, vs 3+) was associated with lower estimated EDDs (1 = -11 [+/-3.6], 2 = -8.9 [+/-3.9], F-test p = .012). On MVA, non-genitourinary (GU) cancer type, number of treatment modalities, and the phase (II or III compared to observational/other) were all significantly associated with higher EDD. Conclusions: Older adults were under-represented in this large sample of trials. This information can be used as a platform to better design disease-specific trials to improve older patient accrual, particularly in disease areas which are under-performing. Support: U10CA180821, U10CA180882, UG1CA189823: https://acknowledgments.alliancefound.org . References: 1. Smith BD et al. J Clin Oncol 27:2758-65, 2009; 2. Hurria A, et al. J Geriatr Oncol 1:40-44, 2010; 3. Pang HH, et al. J Clin Oncol, 2016.[Table: see text]
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Affiliation(s)
| | | | | | | | | | - Reshma Jagsi
- University of Michigan Health System, Ann Arbor, MI
| | | | - Rachel A. Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Hyman B. Muss
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Arti Hurria
- City of Hope National Medical Center, Duarte, CA
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Rubinstein MM, Caird I, Zhou Q, Iasonos A, Friedman CF, Cadoo KA, Konner JA, O'Cearbhaill RE, Tew WP, Zamarin D, Grisham RN, Kyi C, Soldan K, Lichtman SM, Ligresti L, Schweber SJ, Singh JC, Troso-Sandoval TA, Aghajanian C, Makker V. A phase II trial of durvalumab with or without tremelimumab in patients with persistent or recurrent endometrial carcinoma and endometrial carcinosarcoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5582] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5582 Background: Monoclonal antibodies Durvalumab (D) and Tremelimumab (T) inhibit binding of programmed cell death ligand 1 (PDL1) to PD1 and inhibit activation of cytotoxic T-lymphocyte-associated protein 4 (CTLA4), respectively, resulting in improved tumor immunosurveillance. There is rationale to study D and DT based on recent genomic and tumor microenvironment evaluation of endometrial cancer (EC). Methods: Eligible patients (pts) were randomized to D or DT. Pts received D 1500 mg intravenously (IV) every 4 weeks (wks). DT therapy pts received D 1500 mg IV every 4 wks and T 75 mg IV every 4 wks for 4 cycles, followed by D 1500 mg IV every 4 wks until progression or unacceptable toxicities. Pts were stratified by histology with 10 carcinosarcoma or MSI-H EC pts per arm. Efficacy assessments were every 8 wks and treatment related adverse events (TRAEs) were assessed per CTCAE v.4.03. The primary endpoint was overall response rate (ORR) by RECIST v1.1. Descriptive statistics and 90% one sided CI are reported. Progression free survival (PFS) rate at 24 wks (PFS24wks) was estimated by Kaplan Meier method. Results: At planned interim analysis, 56 pts were enrolled (28 per arm). 15 pts: carcinosarcoma, 15 pts: endometrioid (3: Gr1), 14 pts: serous, and 12 pts: other histology. 5(9%) pts: MSI-H, 48(86%) pts: microsatellite stable (MSS), 3(5%): unknown. 2 pts were excluded due to early death. 27 pts per arm were evaluable for efficacy. In the D arm: 1 pt had complete response (CR)(MSS) and 3 pts had a partial response (PR) (2:MSS, 1:MSI-H) with an ORR of 14.8% (CI: 6.6-100%). The median PFS was 7.6 wks and PFS24wks was 13.3% (CI 6.1-100%). Median duration of response (DOR) was 16 wks in the D arm. In the DT arm, 2 pts achieved CR (1:MSI-H, 1:MSS) and 1 had PR (MSS). The ORR was 11.1% (CI: 4.2-100%). Median PFS was 8.1 wks, PFS24wks was 18.5% (CI 10.1-100%) and DOR was 8 wks. Grade 3 TRAEs occurred in 2 (7%) pts in D and 9 (32%) pts in DT. Grade 4 TRAEs occurred 1 (4%) pt in D and 3 (11%) pts in DT. 2 pts discontinued due to a TRAE. Most common TRAEs in total were fatigue (23%), diarrhea (20%), nausea (14%), vomiting (13%) and pruritis (11%). Conclusions: D and DT show modest activity in EC. No new safety signals were identified. Second stage accrual is ongoing. Clinical trial information: NCT03015129.
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Affiliation(s)
| | - Imogen Caird
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - William P. Tew
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | - Rachel N. Grisham
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Chrisann Kyi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | - Vicky Makker
- Memorial Sloan Kettering Cancer Center, New York, NY
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VanderWalde NA, Moughan J, Lichtman SM, Jagsi R, Ballo MT, Vanderwalde AM, Mohiuddin M, Meropol NJ, Kachnic LA, Garofalo MC, Ajani JA, Beart RW, Anne R, Evans LS, Arora A, Meyer JE, Lee JJ, Keech JA, Soori GS, Crane CH. The association of age with acute toxicities in NRG oncology combined modality lower GI cancer trials. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
649 Background: This study sought to compare adverse events (AEs) of older and younger adults with lower gastrointestinal (GI) malignancies treated on NRG studies. Methods: Data from six NRG trials (RTOG 9811/0012/0247/0529/0822 & NSABP R-04), testing combined modality therapy (radiation and chemotherapy) in patients with anal or rectal cancer, were collected to test the hypothesis that older age was associated with increase in acute ( ≤ 90 days from treatment start) AEs. AEs were defined as GI, Genitourinary (GU), hematologic, or skin. AEs and compliance with protocol-directed therapy were compared between patients aged ≥ 70 years and < 70 years. Categorical variables were compared across age groups using the chi-square test. The association of age on AEs was evaluated using a covariate-adjusted logistic regression model, with odds ratio (OR) reported. To adjust for multiple comparisons, a p-value < 0.01 was considered statistically significant. Results: Data from 2525 patients were collected (43% female, 72% rectal cancer). There were 380 patients ≥ 70 years old (15%). Older patients were more likely to have worse baseline performance status (PS 1 or 2) (23% vs. 16%, p <0.01), but otherwise baseline characteristics were similar. Older patients were less likely to have completed their chemotherapy (78% vs. 87%, p < 0.01), but had similar median RT duration. On univariate analysis, patients ≥ 70 were more likely to experience grade ≥ 3 GI AEs (36% vs. 23%, OR 1.82, p < 0.001), and less likely to experience ≥ 3 skin AEs (8% vs. 14%, OR 0.56, p = 0.002). There was no difference between GU or hematologic AEs. On multivariable analysis, age ≥ 70 was associated with grade ≥ 3 GI AE (OR 1.80, 95% CI: 1.40, 2.31; p < 0.001) after adjusting for gender, PS, T stage, disease site, RT duration, and chemotherapy completion. Conclusions: Older patients with curable lower GI cancers who underwent combined-modality therapy were less likely to complete chemotherapy and were more likely to experience serious GI toxicity, whereas younger patients had higher rates of serious skin AEs.
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Affiliation(s)
- Noam Avraham VanderWalde
- Department of Radiation Oncology, University of Tennessee Health Science Center/West Cancer Center, Memphis, TN
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center - ACR, Philadelphia, PA
| | | | - Reshma Jagsi
- University of Michigan Health System, Ann Arbor, MI
| | - Matthew T. Ballo
- Department of Radiation Oncology, University of Tennessee Health Science Center/West Cancer Center, Memphis, TN
| | - Ari M. Vanderwalde
- Division of Hematology/Oncology, The University of Tennessee Health Science Center, West Cancer Center, Germantown, TN
| | | | - Neal J. Meropol
- Flatiron Health, New York, NY and Case Comprehensive Cancer Center, Cleveland, OH
| | | | | | | | | | - Rani Anne
- Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - James J. Lee
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | - Gamini S. Soori
- NRG Oncology/NSABP, and Nebraska Cancer Specialists, Omaha, NE
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Liposits G, Loh KP, Soto-Perez-de-Celis E, Dumas L, Battisti NML, Kadambi S, Baldini C, Banerjee S, Lichtman SM. PARP inhibitors in older patients with ovarian and breast cancer: Young International Society of Geriatric Oncology review paper. J Geriatr Oncol 2018; 10:337-345. [PMID: 30333088 DOI: 10.1016/j.jgo.2018.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/16/2018] [Accepted: 10/10/2018] [Indexed: 01/28/2023]
Abstract
Breast and ovarian cancer are common malignancies among older adults, causing significant morbidity and mortality. Although most cases of breast and ovarian cancer are sporadic, a significant proportion is caused by mutations in cancer susceptibility genes, most often breast cancer susceptibility genes (BRCA) 1 and 2. Furthermore, some breast and ovarian tumors are phenotypically similar to those with BRCA mutations, a phenomenon known as "BRCAness". BRCA mutations and "BRCAness" lead to defects in DNA repair, which may be a target for therapeutic agents such as Poly ADP-Ribose Polymerase (PARP) inhibitors. PARP inhibitors are novel medications which lead to double-strand breaks resulting in cell death due to synthetic lethality, and which have been shown to be effective in patients with advanced breast and ovarian cancers with or without BRCA mutations. Three different PARP inhibitors (olaparib, niraparib, and rucaparib) have been approved for the treatment of ovarian cancer and one (olaparib) for breast cancer harboring BRCA mutations. Here, we review the currently available evidence regarding the use of PARP inhibitors for the treatment of patients with breast and ovarian cancer, with a particular focus on the inclusion of older adults in clinical trials of these therapies. Additionally, we provide an overview of currently ongoing studies of PARP inhibitors in breast and ovarian cancer, and include recommendations for increasing the evidence-base for using these medications among older patients.
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Affiliation(s)
- Gabor Liposits
- Department of Oncology, Region Hospital West Jutland, Gl. Landevej 61, Herning, 7400, Denmark.
| | - Kah Poh Loh
- Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Enrique Soto-Perez-de-Celis
- Enrique Soto-Perez-de-Celis Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
| | - Lucy Dumas
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.
| | | | - Sindhuja Kadambi
- Division of Geriatrics/Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Capucine Baldini
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France.
| | - Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust Sutton, United Kingdom.
| | - Stuart M Lichtman
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, NY, USA.
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Soto-Perez-de-Celis E, Sun CL, Tew WP, Mohile SG, Gajra A, Klepin HD, Owusu C, Gross CP, Muss HB, Lichtman SM, Chapman AE, Cohen HJ, Dale W, Kim H, Fernandes S, Katheria V, Hurria A. Association between patient-reported hearing and visual impairments and functional, psychological, and cognitive status among older adults with cancer. Cancer 2018; 124:3249-3256. [PMID: 29797664 DOI: 10.1002/cncr.31540] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/09/2018] [Accepted: 04/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hearing and visual impairments are common among community-dwelling older adults, and are associated with psychological, functional, and cognitive deficits. However, to the authors' knowledge, little is known regarding their prevalence among older patients with cancer. METHODS The current study was a secondary analysis combining 2 prospective cohorts of adults aged ≥65 years with solid tumors who were receiving chemotherapy. The authors assessed the association between patient-reported hearing and/or visual impairment (defined as fair/poor grading by self-report) and physical function, instrumental activities of daily living (IADLs), anxiety, depression, and cognition. Descriptive analyses were conducted to summarize patient and treatment characteristics. One-way analysis of variance and chi-square tests were conducted as appropriate to examine differences between patients with and without sensory impairments. Logistic regression was used to analyze associations between sensory impairments and outcomes. RESULTS Among 750 patients with a median age of 72 years who had solid tumors (29% with breast/gynecological tumors, 28% with lung tumors, and 27% with gastrointestinal tumors), approximately 18% reported hearing impairment alone, 11% reported visual impairment alone, and 7% reported dual sensory impairment. Hearing impairment was associated with IADL dependence (odds ratio [OR], 1.9), depression (OR, 1.6), and anxiety (OR, 1.6). Visual impairment was associated with IADL dependence (OR, 1.9), poor physical function (OR, 1.9), and depression (OR, 2.5). Dual impairment was associated with IADL dependence (OR, 2.8), anxiety (OR, 2.3), depression (OR, 2.5), and cognitive impairment (OR, 3.2). CONCLUSIONS Sensory impairment is common among older adults with cancer. Patients with sensory impairment are more likely to have functional, psychological, and cognitive deficits. Interventions aimed at improving the vision and hearing of older adults with cancer should be studied. Cancer 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Enrique Soto-Perez-de-Celis
- Cancer and Aging Research Program, City of Hope, Duarte, California.,Department of Geriatrics, Salvador Zubiran National Institute of Medical Science and Nutrition, Mexico City, Mexico
| | - Can-Lan Sun
- Cancer and Aging Research Program, City of Hope, Duarte, California
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Supriya Gupta Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Ajeet Gajra
- ICON Clinical Research, North Wales, Pennsylvania
| | - Heidi D Klepin
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Cynthia Owusu
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Cary Philip Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Hyman B Muss
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stuart M Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew E Chapman
- Jefferson Senior Adult Oncology Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Harvey Jay Cohen
- Center for the Study of Aging & Human Development, Duke University Medical Center, Durham, North Carolina
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, California
| | - Heeyoung Kim
- Cancer and Aging Research Program, City of Hope, Duarte, California
| | - Simone Fernandes
- Cancer and Aging Research Program, City of Hope, Duarte, California
| | - Vani Katheria
- Cancer and Aging Research Program, City of Hope, Duarte, California
| | - Arti Hurria
- Cancer and Aging Research Program, City of Hope, Duarte, California
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Mohile SG, Dale W, Somerfield MR, Schonberg MA, Boyd CM, Burhenn PS, Canin B, Cohen HJ, Holmes HM, Hopkins JO, Janelsins MC, Khorana AA, Klepin HD, Lichtman SM, Mustian KM, Tew WP, Hurria A. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol 2018; 36:2326-2347. [PMID: 29782209 DOI: 10.1200/jco.2018.78.8687] [Citation(s) in RCA: 844] [Impact Index Per Article: 140.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To provide guidance regarding the practical assessment and management of vulnerabilities in older patients undergoing chemotherapy. Methods An Expert Panel was convened to develop clinical practice guideline recommendations based on a systematic review of the medical literature. Results A total of 68 studies met eligibility criteria and form the evidentiary basis for the recommendations. Recommendations In patients ≥ 65 years receiving chemotherapy, geriatric assessment (GA) should be used to identify vulnerabilities that are not routinely captured in oncology assessments. Evidence supports, at a minimum, assessment of function, comorbidity, falls, depression, cognition, and nutrition. The Panel recommends instrumental activities of daily living to assess for function, a thorough history or validated tool to assess comorbidity, a single question for falls, the Geriatric Depression Scale to screen for depression, the Mini-Cog or the Blessed Orientation-Memory-Concentration test to screen for cognitive impairment, and an assessment of unintentional weight loss to evaluate nutrition. Either the CARG (Cancer and Aging Research Group) or CRASH (Chemotherapy Risk Assessment Scale for High-Age Patients) tools are recommended to obtain estimates of chemotherapy toxicity risk; the Geriatric-8 or Vulnerable Elders Survey-13 can help to predict mortality. Clinicians should use a validated tool listed at ePrognosis to estimate noncancer-based life expectancy ≥ 4 years. GA results should be applied to develop an integrated and individualized plan that informs cancer management and to identify nononcologic problems amenable to intervention. Collaborating with caregivers is essential to implementing GA-guided interventions. The Panel suggests that clinicians take into account GA results when recommending chemotherapy and that the information be provided to patients and caregivers to guide treatment decision making. Clinicians should implement targeted, GA-guided interventions to manage nononcologic problems. Additional information is available at www.asco.org/supportive-care-guidelines .
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Affiliation(s)
- Supriya G Mohile
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - William Dale
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Mark R Somerfield
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Mara A Schonberg
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Cynthia M Boyd
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Peggy S Burhenn
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Beverly Canin
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Harvey Jay Cohen
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Holly M Holmes
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Judith O Hopkins
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Michelle C Janelsins
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Alok A Khorana
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Heidi D Klepin
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Stuart M Lichtman
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Karen M Mustian
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - William P Tew
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Arti Hurria
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
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Loh KP, Soto-Perez-de-Celis E, Hsu T, de Glas NA, Battisti NML, Baldini C, Rodrigues M, Lichtman SM, Wildiers H. What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper. J Oncol Pract 2018; 14:85-94. [PMID: 29436306 PMCID: PMC5812308 DOI: 10.1200/jop.2017.026435] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology.
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Affiliation(s)
- Kah Poh Loh
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Enrique Soto-Perez-de-Celis
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Tina Hsu
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Nienke A. de Glas
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Nicolò Matteo Luca Battisti
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Capucine Baldini
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Manuel Rodrigues
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Stuart M. Lichtman
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
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Lichtman SM, Harvey RD, Damiette Smit MA, Rahman A, Thompson MA, Roach N, Schenkel C, Bruinooge SS, Cortazar P, Walker D, Fehrenbacher L. Modernizing Clinical Trial Eligibility Criteria: Recommendations of the American Society of Clinical Oncology–Friends of Cancer Research Organ Dysfunction, Prior or Concurrent Malignancy, and Comorbidities Working Group. J Clin Oncol 2017; 35:3753-3759. [DOI: 10.1200/jco.2017.74.4102] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with organ dysfunction, prior or concurrent malignancies, and comorbidities are often excluded from clinical trials. Excluding patients on the basis of these factors results in clinical trial participants who are healthier and younger than the overall population of patients with cancer. Methods ASCO and Friends of Cancer Research established a multidisciplinary working group that included experts in trial design and conduct to examine how eligibility criteria could be more inclusive. The group analyzed current eligibility criteria; conducted original data analysis; considered safety concerns, potential benefits, research, and potential hurdles of this approach through discussion; and reached consensus on recommendations regarding updated eligibility criteria that prioritize inclusiveness without compromising patient safety. Results If renal toxicity and clearance are not of direct treatment-related concern, then patients with lower creatinine clearance values of > 30 mL/min should be included in trials. Inclusion of patients with mild to moderate hepatic dysfunction may be possible when the totality of the available nonclinical and clinical data indicates that inclusion is safe. Ejection fraction values should be used with investigator assessment of a patient’s risk for heart failure to determine eligibility. Patients with laboratory parameters out of normal range as a result of hematologic disease should be included in trials. Measures of patient functional status should be included in trials to better assess fit versus frail patients. Conclusion Expanding inclusion of these patients will increase the number and diversity of patients in clinical trials and result in a more appropriate population of patients.
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Affiliation(s)
- Stuart M. Lichtman
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - R. Donald Harvey
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Marie-Anne Damiette Smit
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Atiqur Rahman
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Michael A. Thompson
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Nancy Roach
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Caroline Schenkel
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Suanna S. Bruinooge
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Patricia Cortazar
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Dana Walker
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Louis Fehrenbacher
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
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Kim ES, Bruinooge SS, Roberts S, Ison G, Lin NU, Gore L, Uldrick TS, Lichtman SM, Roach N, Beaver JA, Sridhara R, Hesketh PJ, Denicoff AM, Garrett-Mayer E, Rubin E, Multani P, Prowell TM, Schenkel C, Kozak M, Allen J, Sigal E, Schilsky RL. Broadening Eligibility Criteria to Make Clinical Trials More Representative: American Society of Clinical Oncology and Friends of Cancer Research Joint Research Statement. J Clin Oncol 2017; 35:3737-3744. [PMID: 28968170 DOI: 10.1200/jco.2017.73.7916] [Citation(s) in RCA: 308] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose The primary purposes of eligibility criteria are to protect the safety of trial participants and define the trial population. Excessive or overly restrictive eligibility criteria can slow trial accrual, jeopardize the generalizability of results, and limit understanding of the intervention's benefit-risk profile. Methods ASCO, Friends of Cancer Research, and the US Food and Drug Administration examined specific eligibility criteria (ie, brain metastases, minimum age, HIV infection, and organ dysfunction and prior and concurrent malignancies) to determine whether to modify definitions to extend trials to a broader population. Working groups developed consensus recommendations based on review of evidence, consideration of the patient population, and consultation with the research community. Results Patients with treated or clinically stable brain metastases should be routinely included in trials and only excluded if there is compelling rationale. In initial dose-finding trials, pediatric-specific cohorts should be included based on strong scientific rationale for benefit. Later phase trials in diseases that span adult and pediatric populations should include patients older than age 12 years. HIV-infected patients who are healthy and have low risk of AIDS-related outcomes should be included absent specific rationale for exclusion. Renal function criteria should enable liberal creatinine clearance, unless the investigational agent involves renal excretion. Patients with prior or concurrent malignancies should be included, especially when the risk of the malignancy interfering with either safety or efficacy endpoints is very low. Conclusion To maximize generalizability of results, trial enrollment criteria should strive for inclusiveness. Rationale for excluding patients should be clearly articulated and reflect expected toxicities associated with the therapy under investigation.
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Affiliation(s)
- Edward S Kim
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Suanna S Bruinooge
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Samantha Roberts
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Gwynn Ison
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Nancy U Lin
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Lia Gore
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Thomas S Uldrick
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Stuart M Lichtman
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Nancy Roach
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Julia A Beaver
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Rajeshwari Sridhara
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Paul J Hesketh
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Andrea M Denicoff
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Elizabeth Garrett-Mayer
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Eric Rubin
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Pratik Multani
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Tatiana M Prowell
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Caroline Schenkel
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Marina Kozak
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Jeff Allen
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Ellen Sigal
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
| | - Richard L Schilsky
- Edward S. Kim, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Suanna S. Bruinooge, Caroline Schenkel, and Richard L. Schilsky, ASCO, Alexandria, VA; Samantha Roberts, Marina Kozak, Jeff Allen, and Ellen Sigal, Friends of Cancer Research; Samantha Roberts, Genentech, Washington, DC; Gwynn Ison, Julia A. Beaver, Rajeshwari Sridhara, and Tatiana M. Prowell, US Food and Drug Administration, Silver Spring; Thomas S. Uldrick and Andrea M. Denicoff, National Cancer Institute, Bethesda, MD; Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Paul J. Hesketh, Lahey Health Cancer Institute, Burlington, MA; Lia Gore, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Stuart M. Lichtman, Memorial Sloan-Kettering Cancer Center, New York, NY; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Elizabeth Garrett-Mayer, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Eric Rubin, Merck Research Laboratories, Kenilworth, NJ; and Pratik Multani, Ignyta, San Diego, CA
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Abstract
BACKGROUND The management of elderly patients with cancer is influenced by several factors that can vary widely among aging individuals. As the proportion of elderly individuals increases, the need for specific care guidelines for this population is critical. The National Comprehensive Cancer Network (NCCN) has developed guidelines to address these factors when formulating optimal treatment regimens for elderly patients and to avoid significant toxicity and maintain their quality of life. METHODS Factors that influence the appropriate treatment choices for the elderly, such as functional status, comorbidity, polypharmacy, and the presence of anemia, are reviewed, and the guidelines developed by the NCCN for treatment elderly patients are discussed. RESULTS The guidelines address these factors when defining the goal of therapy and formulating individualized treatment approaches for the elderly to provide optimal care for these patients, avoid significant toxicity, and maintain their quality of life. CONCLUSIONS The goal of therapy must be clearly defined, whether survival, remission, cure, or palliation of symptoms. Enrollment of elderly cancer patients onto clinical trials is encouraged so the guidelines can be validated.
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Affiliation(s)
- Stuart M Lichtman
- Don Monti Division of Medical Oncology, North Shore University Hospital, Manhasset, NY 11030, USA.
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Abstract
Background The number of individuals aged 65 years and older is growing rapidly, and the majority of cancers are diagnosed in this age group. Age-related changes in physiology can affect chemotherapy pharmacokinetics and pharmacodynamics in older patients. Methods We review the literature regarding the impact of age on the pharmacokinetics of commonly used chemotherapy drugs and discuss age-related changes in physiology and pharmacology that can affect chemotherapy tolerance in older patients. Results The data on age-related changes in chemotherapy pharmacokinetics are conflicting. While a few studies report age-related differences in chemotherapy pharmacokinetics, most found no significant difference or subtle differences in pharmacokinetics with aging. A difference in pharmacodynamics was commonly seen, however, with older patients at increased risk of myelosuppression and toxicity from age-related decline in organ function. The majority of these studies were performed in a small cohort of patients, thus limiting the generalizability of these results. Conclusions Additional studies are needed to address the pharmacokinetics and pharmacodynamics of cancer therapies in the older patient. Multicenter pharmacokinetic studies of adequate sample size, which include a thorough evaluation of physiologic factors and geriatric assessment parameters, would provide further insight into the factors affecting treatment tolerance. These studies would also help to guide appropriate chemotherapy dosing and interventions in order to maximize efficacy and minimize toxicity in the older patient.
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Affiliation(s)
- Arti Hurria
- Cancer and Aging Research Program, City of Hope National Medical Center, Duarte, CA 91010, USA.
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Affiliation(s)
- Enrique Soto-Perez-De-Celis
- a Postdoctoral Fellow in Geriatric Oncology , City of Hope National Medical Center , Duarte , CA , USA.,b Department of Geriatrics , Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran , Mexico City , Mexico
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Soto Perez De Celis E, Sun CL, Tew WP, Mohile SG, Gajra A, Klepin HD, Owusu C, Gross CP, Muss HB, Lichtman SM, Chapman AE, Cohen HJ, Dale W, Kim H, Katheria V, Hurria A. Impact of hearing and visual impairment in older adults with cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10036 Background: Hearing and visual impairment increase the risk of psychological, functional, and cognitive deficits in older adults. However, little is known about their impact in older patients (pts) with cancer. Methods: This is a cross-sectional analysis of 2 prospective studies of pts ≥65 with cancer (Hurria et al. JCO 2011 & 2016) which identified risk factors for chemotherapy (CT) toxicity. Relationships between self-reported hearing/visual impairment (fair, poor or deaf/blind) and the need for assistance in instrumental activities of daily living (IADL, i.e. shopping), or activities of daily living (ADL, i.e. bathing); anxiety; depression and cognitive deficit (>11 on Blessed OMC test) were assessed (adjusted for age, sex, race, education, cancer type/stage, comorbidity, falls & medication). Results: Among 750 pts (median age 72, range 65-94) with solid tumors (28% lung, 27% GI, 30% breast/GYN; 58% stage IV), 28% (n = 213) reported 1 impairment (61% hearing, 39% visual) and 7% (n = 55) both. On multivariate analysis, impaired hearing was associated with IADL dependency, anxiety and depression. Visual impairment was associated with IADL dependency, ADL limitation and depression. Impairment in both was associated with IADL dependency, anxiety, depression and cognitive deficit. Conclusions: Older pts with cancer and hearing/visual impairment are at higher risk of functional, psychological and cognitive deficits. Interventions aimed at improving vision and hearing of older adults with cancer should be studied. [Table: see text]
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Affiliation(s)
| | | | | | | | - Ajeet Gajra
- State University of New York Upstate Medical University, Syracuse, NY
| | | | | | | | - Hyman B. Muss
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | | | - William Dale
- University of Chicago Pritzker School of Medicine, Chicago, IL
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Li D, Sun CL, Levi A, Klepin HD, Elias R, Mohile SG, Tew WP, Lim D, Chung VM, Chao J, Owusu C, Muss HB, Lichtman SM, Gross CP, Chapman AE, Gajra A, Cohen HJ, Katheria V, Hurria A. Risk factors for hospitalizations (HOS) among older adults with gastrointestinal (GI) cancers receiving chemotherapy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e21523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21523 Background: Older adults undergoing chemotherapy for GI cancers are at increased risk of HOS due to treatment related toxicity; however, there are limited data regarding which individuals are at greatest risk. We therefore sought to identify risk factors for HOS among older adults with GI cancers receiving chemotherapy. Methods: We performed a secondary analysis of patients age ≥ 65 years with GI cancer who participated in either of 2 prospective studies used to develop (n = 500) and validate (n = 250) a geriatric assessment (GA) based chemotherapy toxicity score for older adults with cancer. The incidence of HOS within 30 days post treatment was determined. The following patient characteristics were captured pre-chemotherapy: demographics, cancer type, stage, laboratory values, chemotherapy type, and GA measures (functional status, comorbidity, psychological state, cognitive function, nutritional status, and social support). Univariate and multivariate logistic regressions were used to estimate the odds ratio (OR) to identify risk factors. Results: A total of 199 adults age 65+ (median 73; range 65-94) with GI cancers (colorectal 43%, gastric/esophageal 25%, pancreas/biliary 32%; Stage I-III 42%, stage IV 58%) receiving chemotherapy (67% poly-chemotherapy) were included. 5-FU chemotherapy was administered alone or in combination in 126 (63%) patients. Sixty five (33%) patients had ≥1 HOS (1 HOS: 55, 2 HOS: 9, 3 HOS: 1). In univariate analysis, hospitalized patients were more likely to be female (p = 0.02), have stage IV disease (p = 0.03), have a diagnosis of non-colorectal GI cancer (p = 0.04), have poly-pharmacy (≥ 5 medications, p < 0.01), decreased hearing (p = 0.05), cardiac comorbidity (p < 0.01), and low serum albumin (p = 0.05). On multivariate analyses, patients who were female (OR = 2.06, 95% CI: 1.05-4.06), with cardiac comorbidity (OR = 3.73, 95% CI: 1.78-7.83), or a diagnosis of stage IV non-colorectal GI cancer (OR = 3.75, 95% CI: 1.50-9.39) were more likely to be hospitalized. Conclusions: HOS during chemotherapy treatment are common among older adults with GI cancers. Female sex, cardiac comorbidity, and a diagnosis of stage IV non-colorectal GI cancer are risk factors for HOS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Joseph Chao
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | - Hyman B. Muss
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | | | - Ajeet Gajra
- State University of New York Upstate Medical University, Syracuse, NY
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Peterson LL, Hurria A, Feng T, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Glezerman I, Katheria V, Zavala L, Smith DD, Sun CL, Tew WP. Association between renal function and chemotherapy-related toxicity in older adults with cancer. J Geriatr Oncol 2016; 8:96-101. [PMID: 27856262 DOI: 10.1016/j.jgo.2016.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/14/2016] [Accepted: 10/31/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the association between renal function (RF) and chemotherapy-related toxicity (CRT) in older adults with cancer and to compare the effect of different RF formulas and body weight measurements on this association. METHODS This is a secondary analysis of data from a prospective multicenter study of patients ≥ age 65 who were starting a new chemotherapy regimen. RF was estimated with 4 formulas (modified Jelliffe [Jelliffe], Cockcroft-Gault [CG], Wright, and Modification of Diet in Renal Disease [MDRD]), using actual, ideal and adjusted body weights for 492 patients. The association between baseline RF and grade 3-5 CRT was evaluated by unconditional logistic regression. RESULTS As a continuous variable, decreased creatinine clearance (CrCl) calculated by CG with actual body weight was associated with increased odds of CRT (OR 1.12, P<0.01; 95% CI 1.04-1.20) indicating that on average for every 10mL/min decrease in CrCl the odds of CRT increased by 12%. Very low RF (in the lowest 10%) with all formulas (CG, Jelliffe, Wright and MDRD) was associated with increased odds for CRT. This association is independent of the type of chemotherapy received (those requiring dose adjustment for renal function vs not). Neither primary dose reduction nor chemotherapy duration was associated with CRT. Serum creatinine alone was not associated with increased odds of CRT (OR 0.67, P=0.15). CONCLUSIONS Decreased RF is associated with increased odds of CRT and should be considered when assessing risk of CRT in older adults with cancer. Serum creatinine alone is not adequate for risk assessment.
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Affiliation(s)
| | - Arti Hurria
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, United States
| | - Tao Feng
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, United States
| | | | - Cynthia Owusu
- Case Western Reserve University, Cleveland, OH, United States
| | - Heidi D Klepin
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Cary P Gross
- Yale Comprehensive Cancer Center, New Haven, CT, United States
| | | | - Ajeet Gajra
- State University of New York Upstate Medical University and Veterans Administration Medical Center, Syracuse, NY, United States
| | | | - Vani Katheria
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, United States
| | - Laura Zavala
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, United States
| | - David D Smith
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, United States
| | - Can-Lan Sun
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, United States
| | - William P Tew
- Memorial Sloan-Kettering Cancer Center, United States
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Gajra A, Loh KP, Hurria A, Muss H, Maggiore R, Dale W, Klepin HD, Magnuson A, Lichtman SM, Williams GR, Shahrokhni A, Mohile SG. Comprehensive Geriatric Assessment-Guided Therapy Does Improve Outcomes of Older Patients With Advanced Lung Cancer. J Clin Oncol 2016; 34:4047-4048. [PMID: 27551131 DOI: 10.1200/jco.2016.67.5926] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Ajeet Gajra
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
| | - Kah Poh Loh
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
| | - Arti Hurria
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
| | - Hyman Muss
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
| | - Ron Maggiore
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
| | - William Dale
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
| | - Heidi D Klepin
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
| | - Allison Magnuson
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
| | - Stuart M Lichtman
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
| | - Grant R Williams
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
| | - Armin Shahrokhni
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
| | - Supriya G Mohile
- Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Kah Poh Loh, University of Rochester, Rochester, NY; Arti Hurria, City of Hope National Medical Center, Duarte, CA; Hyman Muss, University of North Carolina, Chapel Hill, NC; Ron Maggiore, Oregon Health and Science University, Portland, OR; William Dale, University of Chicago, Chicago, IL; Heidi D. Klepin, Wake Forest University, Winston-Salem, NC; Allison Magnuson, University of Rochester, Rochester, NY; Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, New York, NY; Grant R. Williams, University of North Carolina, Chapel Hill, NC; Armin Shahrokhni, Memorial Sloan Kettering Cancer Center, New York, NY; and Supriya G. Mohile, University of Rochester, Rochester, NY
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Cohen HJ, Smith D, Sun CL, Tew W, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Filo J, Katheria V, Hurria A. Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy. Cancer 2016; 122:3865-3872. [PMID: 27529755 DOI: 10.1002/cncr.30269] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Frailty has been suggested as a construct for oncologists to consider in treating older cancer patients. Therefore, the authors assessed the potential of creating a deficit-accumulation frailty index (DAFI) from a largely self-administered comprehensive geriatric assessment (CGA). METHODS Five hundred patients aged ≥65 years underwent a CGA before receiving chemotherapy. A DAFI was constructed, resulting in a 51-item scale, and cutoff values were examined for patients in the robust/nonfrail (cutoff value, 0.0 < 0.2), prefrail (cutoff value, 0.2 < 0.35), and frail (cutoff value, ≥ 0.35) groups. RESULTS Two hundred and fifty patients (50%) were nonfrail, 197 (39%) were prefrail, and 52 (11%) were frail. Older patients (aged ≥ 80 years) and those who had lower education, were living alone, and had higher stage disease were associated with prefrail/frail status. Prefrail/frail patients were more likely to have grade ≥3 toxicity but not to have a dose delay or reduction, and they were more likely to discontinue drug and be hospitalized. The association with grade ≥3 toxicity was attenuated by controlling for a toxicity risk calculator, but the other outcomes were not. CONCLUSIONS A deficit-accumulation frailty index can be constructed from a CGA in older patients with cancer and can indicate the frailty status of the population. The frailty status so determined is associated both with outcomes likely because of chemotherapy toxicity and with those likely because of age-related physiologic and functional deficits and thus can be useful in the overall assessment of the patient. Cancer 2016;122:3865-3872. © 2016 American Cancer Society.
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Affiliation(s)
- Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - David Smith
- QIMR Berghofer Medical Research Institute, Royal Brisbane and Women's Hospital, Brisbane City, Queensland, Australia
| | - Can-Lan Sun
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California
| | - William Tew
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Supriya G Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Cynthia Owusu
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Heidi D Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Cary P Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Stuart M Lichtman
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ajeet Gajra
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York.,Veterans Administration Medical Center, Syracuse, New York
| | - Julie Filo
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California
| | - Vani Katheria
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California
| | - Arti Hurria
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California
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