Neglected geriatric assessment and overtreatment of older patients with pancreatic cancer

• Verfasst von: Betge, Johannes [VerfasserIn]
• Verfasst von: Schulte, Nadine [VerfasserIn]
• Verfasst von: Belle, Sebastian [VerfasserIn]
• Verfasst von: Zhan, Tianzuo [VerfasserIn]
• Verfasst von: Krammer-Steiner, Beate [VerfasserIn]
• Verfasst von: Moulin, Jean-Charles [VerfasserIn]
• Verfasst von: Kleiß, Matthias [VerfasserIn]
• Verfasst von: Lammert, Frank [VerfasserIn]
• Verfasst von: Wedding, Ulrich [VerfasserIn]
• Verfasst von: Räth, Sebastian [VerfasserIn]
• Verfasst von: Maenz, Martin [VerfasserIn]
• Verfasst von: Hegele, Lisa [VerfasserIn]
• Verfasst von: Larcher-Senn, Julian [VerfasserIn]
• Verfasst von: Jesenofsky, Ralf [VerfasserIn]
• Verfasst von: Ebert, Matthias [VerfasserIn]
• Verfasst von: Härtel, Nicolai [VerfasserIn]
• Titel: Neglected geriatric assessment and overtreatment of older patients with pancreatic cancer
• Titelzusatz: results from a prospective phase IV clinical trial
• Verf.angabe: Johannes Betge, Nadine Schulte, Sebastian Belle, Tianzuo Zhan, Beate Krammer-Steiner, Jean-Charles Moulin, Matthias Kleiß, Frank Lammert, Ulrich Wedding, Sebastian Räth, Martin Maenz, Lisa Hegele, Julian Larcher-Senn, Ralf Jesenofsky, Matthias P. Ebert, Nicolai Härtel
• E-Jahr: 2022
• Jahr: June 2022
• Umfang: 5 S.
• Fussnoten: Online verfügbar: 3 January 2022, Artikelversion: 17 June 2022 ; Gesehen am 08.01.2024
• Titel Quelle: Enthalten in: Journal of geriatric oncology
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 2010
• Jahr Quelle: 2022
• Band/Heft Quelle: 13(2022), 5 vom: Juni, Seite 662-666
• ISSN Quelle: 1879-4076
• DOI: doi:10.1016/j.jgo.2021.12.018
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Gemcitabine
• Sach-SW: Geriatric assessment
• Sach-SW: Geriatric oncology
• Sach-SW: Nab-paclitaxel
• Sach-SW: Older patients with cancer
• Sach-SW: Pancreatic cancer
• Sach-SW: Personalized medicine
• K10plus-PPN: 1809931541

Abstract

Background - Older patients with metastatic pancreatic cancer may suffer increased toxicity from intensive chemotherapy. Treatment individualization by geriatric assessment (GA) might improve functional outcome. - Methods - We performed a multicenter, phase IV, open label trial in patients ≥70 years with metastatic pancreatic adenocarcinoma. Patients underwent GA and were assigned to one of three categories based on their scores: Go-Go, Slow-Go, or Frail. These categories were intended to guide physician's treatment decisions when choosing to treat patients with nab-paclitaxel/gemcitabine (arm A), gemcitabine (arm B), or best supportive care (arm C). Primary objective was a stable (loss of five points or less) Barthel's Activities of Daily Living (ADL) score during chemotherapy; secondary endpoints included GA scores during therapy, safety, quality of life, response and survival rates. - Results - Thirty-two patients were enrolled in the trial in six centers in Germany (out of 135 planned), resulting in termination due to low recruitment. Fifteen patients were allocated to nab-paclitaxel/gemcitabine, fifteen to gemcitabine, and two to best supportive care by their physicians, although according to their GA scores 29 patients (91%) were categorized as Slow-Go and three (9%) as Go-Go. Thus, fifteen of 32 (47%) patients were misclassified and given a course of treatment inconsistent with their GA scores. Median progression-free survival (PFS) were 3.3 months and 9.1 months and median time to quality-of-life deterioration 13 days and 29 days in the nab-paclitaxel/gemcitabine and gemcitabine monotherapy arms, respectively. Serious adverse events were reported in 11 (78.6%) patients in the nab-paclitaxel/gemcitabine and 8 (53.3%) patients in the gemcitabine arm. - Conclusions - Clinical evaluations by investigators differed markedly from geriatric assessments, leading to potential overtreatment. In our modest sample size study, those patients undergoing more intensive therapy had a less favorable course.