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Pîslaru AI, Albișteanu SM, Ilie AC, Ștefaniu R, Mârza A, Moscaliuc Ș, Nicoară M, Turcu AM, Grigoraș G, Alexa ID. Lung Cancer: New Directions in Senior Patients Assessment. Geriatrics (Basel) 2024; 9:101. [PMID: 39195131 DOI: 10.3390/geriatrics9040101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/10/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Age is but one significant prognostic factor in lung cancer, influencing survival, treatment response, and outcomes. This narrative review synthesizes findings from searches of 11 leading databases of research studies, systematic reviews, book chapters, and clinical trial reports on lung cancer in senior patients, with a focus on geriatric assessment as well as biomarkers. Key prognostic factors for lung cancer in seniors include biological age, functional capability, physical and psychological comorbidities, frailty, nutrition, status, and biomarkers like DNA methylation age. We identified the most valuable assessments that balance efficacy with quality of life. Optimizing care and improving outcomes with senior lung cancer patients benefits from a tailored therapeutic approach incorporating a complex geriatric assessment. A multidisciplinary collaboration between geriatricians, oncologists, and pulmonologists is crucial.
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Affiliation(s)
- Anca Iuliana Pîslaru
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Sabinne-Marie Albișteanu
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adina Carmen Ilie
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ramona Ștefaniu
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Aurelia Mârza
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ștefan Moscaliuc
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mălina Nicoară
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ana-Maria Turcu
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Gabriela Grigoraș
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Dana Alexa
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
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Lund CM, Nielsen DL, Schultz M, Dolin TG. Physical decline, falls, and hospitalization among vulnerable older patients in the trajectory of colorectal cancer treatment. J Geriatr Oncol 2024:101820. [PMID: 38955634 DOI: 10.1016/j.jgo.2024.101820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/02/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Resilience to anticancer treatment for colorectal cancer (CRC) among older patients varies. Many experience weight loss, physical decline, falls, and hospitalization during treatment, often leading to early discontinuation of otherwise effective chemotherapy. Screening for vulnerability might help to identify patients at risk of these adverse outcomes in older adults. MATERIALS AND METHODS This is a secondary analysis from the GERICO trial. Patients aged ≥70 years assessed for chemotherapy for CRC were screened for eligibility for the GERICO trial with the geriatric-8 (G8) frailty screening tool. The present study population comprised patients who were (1) screened with G8 but for reasons not included in the GERICO study and (2) patients who were randomized to the GERICO control group. We evaluated whether patients identified as vulnerable with G8 (≤14/17) or retrospectively constructed mG8 (≥6/35) had higher risk of experiencing decline in performance status (PS), falls, and unplanned hospitalization during treatment. The association between frailty status and the adverse outcomes was analyzed with univariate and multivariate logistic regression. The discriminative ability of G8/mG8 to predict outcomes was analyzed using the area under the curve for receiver operating characteristics curves. RESULTS In total, 238 patients (median age 74 years [range 70-91]) were included in this analysis. More vulnerable than fit patients experienced decline in PS (G8: 41% vs. 14%, p = 0.006 and mG8: 28% vs. 17%, p = 0.04) during treatment. Furthermore, more vulnerable than fit patients experienced falls (G8 14% vs. 6% p = 0.04) and unplanned hospitalization (G8: 31% vs. 14%, p = 0.009 and mG8: 34% vs. 13%, p < 0.001). Multivariate analyses showed an association between G8 vulnerability and decline in PS, falls, and hospitalization. DISCUSSION Patients with G8 or mG8 vulnerability were more likely to experience decline in PS and unplanned hospitalization during chemotherapy for CRC than fit patients. More G8 vulnerable patients experienced falls compared with fit patients. Appropriate interventions should be offered to older patients with CRC assessed as vulnerable with G8 or mG8 to maintain PS during chemotherapy.
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Affiliation(s)
- Cecilia M Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark.
| | - Dorte L Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark; Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark
| | - Martin Schultz
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Troels G Dolin
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark
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Navarrete-Reyes AP, Mateos-Soria AS, Sánchez-Hernández JJ, Negrete-Najar JP. Frailty and Cancer Prognosis. Curr Oncol Rep 2024:10.1007/s11912-024-01558-x. [PMID: 38865004 DOI: 10.1007/s11912-024-01558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize the current evidence regarding the prognostic role of frailty in older patients diagnosed with cancer and to explore the evidence regarding its prognostic implications in cancer survivors. RECENT FINDINGS Frailty has been consistently associated with mortality/overall survival, postoperative complications, short- and long-term postoperative mortality, length of stay, among other adverse health-related outcomes in several oncological contexts. The possible association between frailty and treatment toxicity has been less explored, however most studies suggest frailty is a predictor of treatment induced toxicity. In addition, in cancer survivors, frailty is a risk factor for cardiovascular disease, incident type 2 diabetes mellitus, mortality, altered cognitive performance and increased symptom severity. Due to its usefulness in establishing prognosis and informing treatment decision making, it is expected that frailty screening and assessment will continue to gain popularity as part of the pretreatment evaluation of older patients with cancer.
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Affiliation(s)
- Ana Patricia Navarrete-Reyes
- Geriatric Medicine Department, Geriatric Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Abigail Samayoa Mateos-Soria
- Geriatric Medicine Department, Geriatric Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Internal Medicine Service, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Juan José Sánchez-Hernández
- Geriatric Medicine Department, Geriatric Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Internal Medicine Service, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Juan Pablo Negrete-Najar
- Geriatric Medicine Service, Hospital General de Zona No. 35, Instituto Mexicano del Seguro Social, Ciudad Juárez, Mexico
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Hu J, Lan J, Xu G. Role of frailty in predicting prognosis of older patients with lung cancer: An updated systematic review and meta-analysis. J Geriatr Oncol 2024:101804. [PMID: 38824058 DOI: 10.1016/j.jgo.2024.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/03/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Frailty is a syndrome affecting primarily older adults that can impact disease course, treatment, and outcomes in patients with lung cancer (LC). We systematically reviewed current data on the correlation between frailty and overall survival (OS), recurrence-free survival (RFS), and the risk of complications in older patients with LC. MATERIALS AND METHODS PubMed, EMBASE, and Scopus databases were searched for observational cohort, cross-sectional, and case-control studies involving participants aged 18 years or older diagnosed with LC. Eligible studies were required to perform frailty assessments and have non-frail participants as a comparator group. Random-effects models were used for analysis, and the reported effect sizes were represented as hazards ratio (HR) or odds ratios (OR) with associated 95% confidence intervals (CI). RESULTS Seventeen studies were included, most with a retrospective cohort design (n = 16) and patients with non-small cell lung carcinoma (NSCLC). Older patients with LC and frailty had lower OS (HR 1.70, 95% CI: 1.39, 2.07) and RFS (HR 2.50, 95% CI: 1.02, 6.12), compared to non-frail subjects. Frail subjects also had increased risk of complications (OR 1.89, 95% CI: 1.42, 2.53). DISCUSSION The observed association between frailty and OS, RFS, and an increased susceptibility to complications emphasizes the potential significance of frailty status as a substantial prognostic indicator. Our results underscore the vital role of including frailty assessment as an integral element within the management plan for patients dealing with lung cancer.
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Affiliation(s)
- Juanping Hu
- Department of Gerontology, Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Jiarong Lan
- Department of Medicine, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, China.
| | - Guangxing Xu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
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Mark M, Froesch P, Gysel K, Rothschild SI, Addeo A, Ackermann CJ, Chiquet S, Schneider M, Ribi K, Maranta AF, Bastian S, von Moos R, Joerger M, Früh M. First-line durvalumab in patients with PD-L1 positive, advanced non-small cell lung cancer (NSCLC) with a performance status of 2 (PS2). Primary analysis of the multicenter, single-arm phase II trial SAKK 19/17. Eur J Cancer 2024; 200:113600. [PMID: 38330766 DOI: 10.1016/j.ejca.2024.113600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/19/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION The safety and efficacy of first-line durvalumab in PS2 patients with advanced NSCLC is unknown. Here, we present the primary analysis of first-line durvalumab in PS2 patients, unsuitable for combination chemotherapy. METHODS In this single-arm, multicenter, phase II trial patients with PD-L1 positive (tumor proportional score ≥25%), advanced NSCLC with PS2, received four-weekly durvalumab 1500 mg. The primary endpoint was overall survival (OS) at 6 months. RESULTS Forty-eight patients were included. Median follow-up was 23.3 months (95% CI: 14.3-28.6). OS at 6 months was 60% (95% CI: 45-74%). Median OS was 8.5 months (95%CI: 4.4-16.7). Objective response rate and median progression free survival were 17% (95% CI: 8-30%) and 2.5 months (95% CI: 1.8-7.1), respectively. Thirty-three deaths were observed at the time point of the analysis. Seven early fatal events considered not treatment-related occurred during the first 5 weeks of treatment. Four out of the first 7 early fatal events (4/7; 57%) were respiratory failure in patients with advanced symptomatic primary lung tumors. Three more early fatal events occurred after exclusion of patients with grade ≥ 3 dyspnea. Treatment-related AEs ≥G3 were reported in 9 patients (19%) and included colonic perforation in one patient (grade 5), colitis in 4 patients (8%), increased lipase in 3 patients (6%), and hepatitis in 2 patients (4%). CONCLUSIONS First-line durvalumab in PS2 patients with advanced PD-L1 positive NSCLC results in a high number of early fatal events. When patients with grade ≥ 3 dyspnea are excluded a promising 6-month OS with an acceptable toxicity profile can be observed. Durvalumab could be an option instead of single agent chemotherapy for PS2 patients who are not candidates for platinum doublet chemotherapy provided they are well selected.
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Affiliation(s)
- Michael Mark
- Division of Oncology/Hematology, Kantonsspital Graubuenden, Chur, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland.
| | - Patrizia Froesch
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Katrin Gysel
- Competence Center Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Sacha I Rothschild
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Basel, Switzerland; Department of Oncology/Hematology, Cantonal Hospital Baden, Switzerland
| | - Alfredo Addeo
- Department of Oncology, University Hospital HUG, Geneva, Switzerland
| | | | - Sabrina Chiquet
- Competence Center Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Martina Schneider
- Competence Center Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Karin Ribi
- ETOP IBCSG Partner Foundation for International Cancer Research, Berne, Switzerland
| | | | - Sara Bastian
- Division of Oncology/Hematology, Kantonsspital Graubuenden, Chur, Switzerland
| | - Roger von Moos
- Division of Oncology/Hematology, Kantonsspital Graubuenden, Chur, Switzerland
| | - Markus Joerger
- Department of Oncology/Hematology, Cantonal Hospital St. Gallen, Switzerland
| | - Martin Früh
- Department of Oncology/Hematology, Cantonal Hospital St. Gallen, Switzerland; University of Bern, Bern, Switzerland
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Doi A, Mizukami T, Takeda H, Umemoto K, Arai H, Horie Y, Izawa N, Ogura T, Sunakawa Y. Clinical utility of geriatric assessment tools in older patients with gastrointestinal cancer. Front Oncol 2023; 13:1110236. [PMID: 37324017 PMCID: PMC10264801 DOI: 10.3389/fonc.2023.1110236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background Geriatric 8 (G8) and instrumental activities of daily living (IADL) are recommended to predict overall survival (OS) or risk of serious adverse events (SAEs) in older cancer patients. However, the clinical utility is relatively unknown in older patients suffering malnutrition with gastrointestinal (GI) cancer, including gastric cancer (GC) and pancreatic cancer (PC). Materials and methods We retrospectively included patients aged ≥65 years with GC, PC, and colorectal cancer (CRC) who received a G8 questionnaire at first visit from April 2018 to March 2020. The associations between G8/IADL and safety or OS were assessed in patients with advanced/unresectable tumors. Results Of 207 patients (median age: 75 years), the median G8 score was 10.5 and normal G8 score rate was 6.8%. Both the median G8 score and normal G8 (>14) score rate numerically increased in the order of GC < PC < CRC. There was no clear association between the G8 standard cutoff value of 14 and SAEs or OS. However, OS was significantly longer in patients with G8 >11 than in those with G8 ≤11 (19.3 vs. 10.5 months, p = 0.0017). Furthermore, OS was significantly better in patients with normal IADL than in those with abnormal IADL (17.6 vs. 11.4 months, p = 0.049). Conclusion The G8 cutoff value of 14 would not be clinically useful in patients with GI cancer for predicting OS or SAEs; however, the cutoff value of 11 and IADL may be useful to predict OS for older patients with GI cancers including GC and PC.
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Affiliation(s)
- Ayako Doi
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Takuro Mizukami
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
- Nippon Telegraph and Telephone Corporation (NTT) Medical Center Tokyo, Department of Medical Oncology, Tokyo, Japan
| | - Hiroyuki Takeda
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Kumiko Umemoto
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Hiroyuki Arai
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Yoshiki Horie
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Naoki Izawa
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Takashi Ogura
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
- Kawasaki Municipal Tama Hospital, Department of Clinical Oncology, Kawasaki, Japan
| | - Yu Sunakawa
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
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Gao J, Zhang P, Tang M, Nie X, Yuan Y, Yang F, Li L. Predictors of immune checkpoint inhibitor-related adverse events in older patients with lung cancer: a prospective real-world analysis. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04792-1. [PMID: 37160811 DOI: 10.1007/s00432-023-04792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Older patients with cancer are underrepresented in pivotal trials of immune checkpoint inhibitors (ICIs). This study aimed to investigate immune-related adverse events (irAEs) that occur in older patients with lung cancer treated with ICIs, and explore predictors of the occurrence of irAEs. METHODS A prospective analysis was performed on older patients with lung cancer aged ≥ 65 years who were treated with anti-programmed cell death-1/-ligand 1 (PD-1/PD-L1) inhibitors in Beijing Hospital from January 2018 to December 2022. The incidence and risk factors of irAEs were estimated by the Chi-square test or Wilcoxon rank-sum tests. The predictive power of Geriatric-8 (G-8) for irAEs was tested by receiver operating characteristic (ROC) curve analysis. Lymphocyte counts were measured by flow cytometry. Cytokine levels were tested by Enzyme-linked immunosorbent assay, respectively. Kaplan-Meier method was used to calculated progression-free survival (PFS) curves, and the log-rank test was used to evaluate differences. RESULTS A total of 201 older patients aged ≥ 65 years with lung cancer were enrolled in this study. The most common irAEs were interstitial pneumonia, dermatological toxicity and hypothyroidism, with rates of 17.2%, 16.1% and 5.6%, respectively. ROC showed that G-8 could predict the occurrence of irAEs in patients aged 65-71 years (≥ G2 irAEs: AUC = 0.757, p < 0.001; ≥ G3 irAEs: AUC = 0.862, p < 0.001), but not for patients aged ≥ 71 years. NLR, LMR, PNI, hypertension and diabetes were associated with irAEs. Lower CD4 + T cells and B cells, and lower levels of IL-10 were associated with the development of irAEs. CONCLUSION Our study confirmed the accuracy of G-8 for predicting irAEs in older patients. We also identified several predictors of irAEs in older patients with lung cancer.
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Affiliation(s)
- Jiayi Gao
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Graduate School Peking Union Medical College, Beijing, 100730, China
| | - Ping Zhang
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Min Tang
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xin Nie
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yue Yuan
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Fan Yang
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lin Li
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
- Graduate School Peking Union Medical College, Beijing, 100730, China.
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Morimoto K, Yamada T, Takeda T, Shiotsu S, Date K, Harada T, Tamiya N, Chihara Y, Takemura Y, Yamada T, Kanda H, Ishida M, Yoshimura A, Iwasaku M, Tokuda S, Kim YH, Takayama K. Prospective Observational Study Evaluating the Prognostic Value of the G8 Screening Tool for Extensive-Stage Small Cell Lung Cancer Patients Who Received Programmed Death-Ligand 1 Inhibitor plus Platinum-Etoposide Chemotherapy. Drugs Aging 2023; 40:563-571. [PMID: 37145245 DOI: 10.1007/s40266-023-01034-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Programmed death-ligand 1 (PD-L1) inhibitor plus platinum-etoposide chemotherapy is used as a first-line treatment for extensive-stage small cell lung cancer (ES-SCLC), regardless of age. OBJECTIVE We examined the role of the Geriatric 8 (G8) screening tool for evaluating treatment outcomes in patients with ES-SCLC treated with PD-L1 inhibitor plus platinum-etoposide chemotherapy as first-line therapy. PATIENTS AND METHODS Between September 2019 and October 2021, we prospectively evaluated patients with ES-SCLC treated with immunochemotherapy at ten institutions in Japan. The G8 score was assessed before treatment initiation. RESULTS We evaluated 44 patients with ES-SCLC. Patients with G8 score > 11 had longer overall survival (OS) than those with G8 score ≤ 11 (not reached versus 8.3 months; log-rank test, p = 0.005). In univariate and multivariate analyses, G8 score > 11 [hazard ratio (HR) 0.34; 95% confidence interval (CI) 0.15-0.75; p = 0.008 and HR 0.34; 95% CI 0.14-0.82; p = 0.02, respectively) and performance status (PS) of 2 (HR 5.42; 95% CI 2.08-14.2; p < 0.001 and HR 6.94; 95% CI 2.25-21.4; p < 0.001, respectively) were independent prognostic factors for OS. Among patients with good PS (0 or 1), the OS in patients with G8 score > 11 was significantly longer than that in patients with G8 score ≤ 11 (not reached versus 12.3 months; log-rank test, p = 0.02). CONCLUSIONS G8 score evaluation before treatment initiation was useful as a prognostic factor for ES-SCLC patients who received PD-L1 inhibitors and platinum-etoposide chemotherapy, even with good PS.
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Affiliation(s)
- Kenji Morimoto
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Takayuki Takeda
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Shinsuke Shiotsu
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koji Date
- Department of Pulmonary Medicine, Kyoto Chubu Medical Center, Kyoto, Japan
| | - Taishi Harada
- Department of Medical Oncology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Nobuyo Tamiya
- Department of Pulmonary Medicine, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Yusuke Chihara
- Department of Respiratory Medicine, Uji-Tokushukai Medical Center, Kyoto, Japan
| | | | - Takahiro Yamada
- Department of Pulmonary Medicine, Matsushita Memorial Hospital, Osaka, Japan
| | - Hibiki Kanda
- Department of Respiratory Medicine, Omi Medical Center, Shiga, Japan
| | - Masaki Ishida
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Akihiro Yoshimura
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Masahiro Iwasaku
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shinsaku Tokuda
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Young Hak Kim
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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Bouzan J, Nellas S, Stoilkov B, Willschrei P, Horstmann M. Item analysis of G8 screening in uro-oncologic geriatric patients. Int Urol Nephrol 2023; 55:1441-1446. [PMID: 37067702 DOI: 10.1007/s11255-023-03594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION/BACKGROUND The G8 score is a widespread screening tool for geriatric frailty in oncology. The aim of this study was to evaluate the scores and relevance of G8 items in a standard screening of geriatric patients with uro-oncologic diseases to better understand the results of the assessment. METHODS Eighty-two consecutive uro-oncologic geriatric patients aged 75 years and older were evaluated. All patients underwent a G8 screening that consisted of 8 items. Patients with a G8 score above 14 were considered geriatric "fit", while others were considered to be "frail". Overall results and single item scores were evaluated. Clinical data were gathered from patients' charts. RESULTS The mean age of the patients was 82 years (min. 75-max. 102). In 36 of the patients, the G8 score indicated "no-frailty", and in 46 patients, the G8 score indicated "frailty". The mean G8 score was 12.9 (min 4-max 17 pts). Item analysis revealed that points were most often lost in items H (polypharmacy), P (comparison of health status to peers) and Age. Fifty-nine, 56 and 52 patients lost points on item Age, item H and item P, respectively. In contrast, the majority of patients reached the maximum score for nutritional items [i.e., items A (food intake), B (weight loss) and F (body mass index (BMI))]. For item A, 73 patients reached the maximum score; for item B, 62 patients reached the maximum score; and for item F, 72 patients reached the maximum score. There were no differences in this distribution pattern when comparing tumour entities, sex, and patients with local vs. metastatic disease. CONCLUSION The present study revealed a high percentage of suspicious test results. Potential reasons for these findings include the low threshold of the G8 overall score and the fact that in some items, points were easily lost. Modifications of the test should be considered.
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Affiliation(s)
- J Bouzan
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - S Nellas
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - B Stoilkov
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - P Willschrei
- Department of Geriatrics, Evang. Hospital Essen-Steele, Am Deimelsberg 34, 45276, Essen, Germany
| | - M Horstmann
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany.
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
- Department of Urology, Klinikum Guetersloh, Reckenberger Str. 19, 33332, Gütersloh, Germany.
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10
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Depoorter V, Vanschoenbeek K, Decoster L, De Schutter H, Debruyne PR, De Groof I, Bron D, Cornélis F, Luce S, Focan C, Verschaeve V, Debugne G, Langenaeken C, Van Den Bulck H, Goeminne JC, Teurfs W, Jerusalem G, Schrijvers D, Petit B, Rasschaert M, Praet JP, Vandenborre K, Milisen K, Flamaing J, Kenis C, Verdoodt F, Wildiers H. Linking clinical and population-based data in older patients with cancer in Belgium: Feasibility and clinical outcomes. J Geriatr Oncol 2023; 14:101428. [PMID: 36804333 DOI: 10.1016/j.jgo.2023.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 11/04/2022] [Accepted: 01/11/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Geriatric screening and geriatric assessment (GS/GA) have proven their benefits in the care for older patients with cancer. However, less is known about the predictive value of GS/GA for outcomes. To research this, clinical data on GS/GA can be enriched with population-based data. In this article we describe the methods and feasibility of data linkage, and first clinical outcomes (GS/GA results and overall survival). MATERIALS AND METHODS A large cohort study consisting of patients aged ≥70 years with a new cancer diagnosis was established using linked data from clinical and population-based databases. Clinical data were derived from a previous prospective study where older patients with cancer were screened with G8, followed by GA in case of an abnormal result (GS/GA study; 2009-2015). These data were linked to cancer registration data from the Belgian Cancer Registry (BCR), reimbursement data of the health insurance companies (InterMutualistic Agency, IMA), and hospital discharge data (Technical Cell, TCT). Cox regression analyses were conducted to evaluate the prognostic value of the G8 geriatric screening tool. RESULTS Of the 8067 eligible patients with a new cancer diagnosis, linkage of data from the GS/GA study and data from the BCR was successful for 93.7%, resulting in a cohort of 7556 patients available for the current analysis. Further linkage with the IMA and TCT database resulted in a cohort of 7314 patients (96.8%). Based on G8 geriatric screening, 67.9% of the patients had a geriatric risk profile. Malnutrition and functional dependence were the most common GA-identified risk factors. An abnormal baseline G8 score (≤14/17) was associated with lower overall survival (adjusted HR [aHR] = 1.62 [1.50-1.75], p < 0.001). DISCUSSION Linking clinical and population-based databases for older patients with cancer has shown to be feasible. The GS/GA results at cancer diagnosis demonstrate the vulnerability of this population and the G8 score showed prognostic value for overall survival. The established cohort of almost 8000 patients with long-term follow-up will serve as a basis in the future for detailed analyses on long-term outcomes beyond survival.
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Affiliation(s)
| | | | - Lore Decoster
- Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Oncologisch Centrum - Department of Medical Oncology, Brussels, Belgium
| | | | - Philip R Debruyne
- General Hospital Groeninge, Kortrijk Cancer Centre, Kortrijk, Belgium; Anglia Ruskin University, Medical Technology Research Centre (MTRC), School of Life Sciences, Cambridge, UK; University of Plymouth, School of Nursing & Midwifery, Plymouth, UK
| | - Inge De Groof
- Iridium Cancer Network Antwerp - Sint-Augustinus, Department of Geriatric Medicine, Wilrijk, Belgium
| | - Dominique Bron
- ULB Institute Jules Bordet, Department of Hematology, Brussels, Belgium
| | - Frank Cornélis
- Cliniques Universitaires Saint-Luc - UCLouvain, Department of Medical Oncology, Brussels, Belgium
| | - Sylvie Luce
- University Hospital Erasme- Université Libre de Bruxelles ULB, Department Medical Oncology, Brussels, Belgium
| | - Christian Focan
- Clinique CHC-MontLégia, Groupe Santé CHC-Liège, Department of Oncology, Liège, Belgium
| | - Vincent Verschaeve
- GHDC Grand Hôpital de Charleroi, Department of Medical Oncology, Charleroi, Belgium
| | - Gwenaëlle Debugne
- Centre Hospitalier de Mouscron, Department of Geriatric Medicine, Mouscron, Belgium
| | | | | | | | - Wesley Teurfs
- ZNA Stuivenberg, Department Medical Oncology, Antwerp, Belgium
| | - Guy Jerusalem
- Centre Hospitalier Universitaire Sart Tilman - Liège University, Department of Medical Oncology, Liège, Belgium
| | - Dirk Schrijvers
- ZNA Middelheim, Department of Medical Oncology, Antwerp, Belgium
| | - Bénédicte Petit
- Centre Hospitalier Jolimont, Department of Medical Oncology, La Louvière, Belgium
| | - Marika Rasschaert
- University Hospital Antwerp, Department of Medical Oncology, Edegem, Belgium
| | - Jean-Philippe Praet
- CHU St-Pierre - Free Universities Brussels, Department of Geriatric Medicine, Brussels, Belgium
| | | | - Koen Milisen
- University Hospitals Leuven - KU Leuven, Department of Geriatric Medicine - Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Johan Flamaing
- University Hospitals Leuven - KU Leuven, Department of Geriatric Medicine - Department of Public Health and Primary Care, Gerontology and Geriatrics, Leuven, Belgium
| | - Cindy Kenis
- University Hospitals Leuven, Department of General Medical Oncology - Department of Geriatric Medicine, Leuven, Belgium
| | - Freija Verdoodt
- Belgian Cancer Registry, Research Department, Brussels, Belgium
| | - Hans Wildiers
- University Hospitals Leuven - KU Leuven, Department of General Medical Oncology - Department of Oncology, Leuven, Belgium.
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11
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Wu X, Kumar R, Milner-Watts C, Walder D, Battisti NML, Minchom A, Bhosle J, O'Brien MER. The Predictive Value of the G8 Questionnaire in Older Patients with Lung Cancer or Mesothelioma before Systemic Treatment. Clin Oncol (R Coll Radiol) 2023; 35:e163-e172. [PMID: 36402621 DOI: 10.1016/j.clon.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/21/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
Abstract
AIMS The standard evaluation of older lung cancer or mesothelioma patients for systemic anti-cancer treatment, based on performance status, is inaccurate. We used the G8 questionnaire to assess a patient's fitness for chemotherapy and explored the correlations between G8 scores, treatment decisions and clinical outcomes. MATERIALS AND METHODS In total, 201 older patients (≥70 years) with advanced lung cancer or mesothelioma were prospectively assessed by standard clinical methods and a G8 questionnaire. Treatment decisions before and after reviewing the G8 score were documented. Patients were divided into low (<11), intermediate (11-14) and high (>14) G8 score groups. Patients' characteristics, treatment plans and clinical outcomes among each G8 score group were compared. Similar analyses were compared between good (<2) and poor (≥2) performance status. RESULTS 10.1% of patients' treatment plans changed after oncologists reviewed G8 scores. The G8 score correlated inversely with performance status. More patients with low G8 scores (22.5%) were offered the best supportive care compared with 4.5% in intermediate and 1.9% in high G8 score groups. More patients (30.1%) with low G8 scores had treatment changed from chemotherapy to best supportive care on the planned day of their treatment, compared with intermediate (7.5%) and high (6.1%) G8 score groups. High G8 score patients received higher chemotherapy intensity and survived longer than patients with intermediate or low G8 scores. CONCLUSIONS The G8 score with two cut-off values can predict functional status, chemotherapy tolerability and prognosis in older patients with lung cancer or mesothelioma, thus supporting oncologists on treatment decisions for this population.
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Affiliation(s)
- X Wu
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - R Kumar
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - D Walder
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - A Minchom
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - J Bhosle
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - M E R O'Brien
- The Royal Marsden NHS Foundation Trust, Sutton, UK. Mary.O'
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12
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Langballe R, Dalton SO, Jakobsen E, Karlsen RV, Iachina M, Freund KM, Leclair A, Nielsen AS, Andersen EAW, Rosthøj S, Jørgensen LB, Skou ST, Bidstrup PE. NAVIGATE: improving survival in vulnerable patients with lung cancer through nurse navigation, symptom monitoring and exercise - study protocol for a multicentre randomised controlled trial. BMJ Open 2022; 12:e060242. [PMID: 36316074 PMCID: PMC9628541 DOI: 10.1136/bmjopen-2021-060242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION AND AIM Low socioeconomic position (SEP) has been shown to be strongly associated with impaired lung cancer survival. Barriers related to receiving recommended treatment among patients with lung cancer with low SEP may include adverse health behaviour and limited physical and psychosocial resources influencing the ability to react on high-risk symptoms and to navigate the healthcare system. To address the underlying factors that drive both decisions of treatment, adherence to treatment and follow-up in vulnerable patients with lung cancer, we developed the Navigate intervention. The aim of this randomised controlled trial is to investigate the effect of the intervention on survival (primary outcome), lung cancer treatment adherence, health-related quality of life and other psychosocial outcomes as well as health costs and process evaluation (secondary outcomes) in a study population of vulnerable patients with lung cancer. METHODS AND ANALYSIS This two-armed multicentre randomised trial will recruit patients from five lung cancer clinics in Denmark identified as vulnerable according to a screening instrument with nine clinical and patient-reported vulnerability criteria developed for the study. We will enrol 518 vulnerable patients >18 years old diagnosed with non-small cell lung cancer at all stages with a performance status <2. Participants will be randomly allocated to either standard treatment and intervention or standard treatment alone. The Navigate intervention is based on principles from motivational interviewing and includes three components of nurse navigation, systematic monitoring of patient-reported outcomes (PROs) and physical exercise in a person-centred delivery model. Data will be collected at baseline and 3, 6, 12 months after randomisation using questionnaires, clinical data and physical function tests. ETHICS AND DISSEMINATION Ethics Committee, Region Zealand (SJ-884/EMN-2020-37380) and the Data Protection Agency in Region Zealand (REG-080-2021) approved the trial. Participants will provide written informed consent. Results will be reported in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05053997.
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Affiliation(s)
- Rikke Langballe
- Psychological Aspects of Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Susanne Oksbjerg Dalton
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Survivorship and Inequality in Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
- The Danish Lung Cancer Registry, Odense University Hospital, Odense, Denmark
| | - Randi Valbjørn Karlsen
- Psychological Aspects of Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Iachina
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense Universityhospital, Odense, Denmark
| | - Karen M Freund
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Amy Leclair
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | | | - Susanne Rosthøj
- Statistics and Data Analysis, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Lars Bo Jørgensen
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Roskilde, Denmark
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Søren Thorgaard Skou
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
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13
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Fletcher JA, Fox ST, Reid N, Hubbard RE, Ladwa R. The impact of frailty on health outcomes in older adults with lung cancer: A systematic review. Cancer Treat Res Commun 2022; 33:100652. [PMID: 36306604 DOI: 10.1016/j.ctarc.2022.100652] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Frailty is prevalent in older adults with lung cancer, however the impact of frailty in this population is not well understood. The aim of this review was to evaluate the outcomes that are measured in frail older adults with lung cancer, and to determine the associations between frailty and these outcomes. METHODS A systematic online search of PubMed, EMBASE, and Cochrane databases was conducted to identify all English-language studies between January 2015 and May 2022 prospectively evaluating frailty and outcomes in older adults (median age > 65 years) with lung cancer. Studies were excluded if frailty was defined by a single domain assessment or not clearly defined. Quality was assessed using the Newcastle-Ottawa Scale. RESULTS Of 1891 studies screened, 16 met inclusion criteria. The median number of patients was 96 (range 26-494) and the mean age was 76.6 years. Eight different frailty assessments were used, and frailty definitions varied widely. The most frequently assessed outcomes were overall survival (n = 13,81%), treatment-related toxicity (n = 8,50%), hospitalisation (n = 5,31%), and treatment completion/discontinuation (n = 4,25%). Quality of life (n = 3,19%), function (n = 1,6%), frailty trajectory (n = 1,6%), and emergency visits (n = 1,6%) were infrequently assessed. Frailty had a strong and consistent association with mortality (Hazard Ratio range: 3.5-11.91). It was also associated with treatment-related toxicity and treatment selection. The remaining outcomes were not statistically significant. CONCLUSION These data support frailty as an important predictor of mortality in older adults with lung cancer, however further research is warranted to determine the association between frailty and other meaningful endpoints for this vulnerable population.
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Affiliation(s)
- James A Fletcher
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia; Faculty of Medicine, The University of Queensland. 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia.
| | - Sarah T Fox
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia; The Prince Charles Hospital, 627 Rode Rd, Chermside, Queensland, QLD 4032, Australia
| | - Natasha Reid
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Ruth E Hubbard
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Rahul Ladwa
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia; Faculty of Medicine, The University of Queensland. 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia
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14
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Umemoto K, Yamamoto H, Oikawa R, Takeda H, Doi A, Horie Y, Arai H, Ogura T, Mizukami T, Izawa N, Moore JA, Sokol ES, Sunakawa Y. The Molecular Landscape of Pancreatobiliary Cancers for Novel Targeted Therapies From Real-World Genomic Profiling. J Natl Cancer Inst 2022; 114:1279-1286. [PMID: 35583261 PMCID: PMC9468278 DOI: 10.1093/jnci/djac106] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/04/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chemotherapies have limited efficacy in pancreatic cancer (PC) and biliary tract cancer (BTC), underscoring the need for new regimens. Recently, tumor-agnostic approaches have been developed for some targeted therapies in advanced solid tumors; however, the frequency of alterations by clinical and genomic background is unclear in PC and BTC. METHODS To assess the frequencies of druggable gene alterations and investigate new potential therapeutic targetable genomic alterations, advanced PC and BTC patients were tested with comprehensive genomic profiling at Foundation Medicine during the course of clinical care. RESULTS A total of 16 913 PC patients and 3031 BTC patients were available for analyses, and frequencies of genomic alterations were stratified by age (≥40 years or <40 years), microsatellite instability status, tumor mutational burden status (high ≥10 or low <10 Muts/Mb), and select genomic alterations. Alterations in BRCA2, BRAF, ERBB2, CDK12, PIK3CA, FGFR2, EGFR, and other potential targets were seen across cohorts, with enrichment observed within particular subsets such as in PC patients lacking a KRAS mutation. In BTC patients, the rate of ERBB2 amplification was statistically significantly higher in the tumor mutational burden-high population (23.3% vs 13.7%). Interestingly, CDK12 rearrangement was observed in BTC patients with ERBB2 amplification tumors. In patients younger than 40 years, FGFR2 rearrangement (4%) was observed in PC: GATA6 amplification (11.1%) and rearrangement of BRAF (2.8%)FGFR2 (5.6%) was observed in BTC patients. CONCLUSIONS We identified an appreciable frequency of immunotherapy biomarkers and targetable gene alterations in both PC and BTC, with notable frequencies in PC samples lacking KRAS mutations and children or adolescent and young adult populations, that should encourage comprehensive genomic profiling testing.
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Affiliation(s)
- Kumiko Umemoto
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Yamamoto
- Department of Bioinformatics, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
- Division of Gastroenterology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ritsuko Oikawa
- Division of Gastroenterology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Takeda
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayako Doi
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshiki Horie
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Arai
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takashi Ogura
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takuro Mizukami
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Izawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Jay A Moore
- Cancer Genomics Research, Foundation Medicine, Cambridge, MA, USA
| | - Ethan S Sokol
- Cancer Genomics Research, Foundation Medicine, Cambridge, MA, USA
| | - Yu Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
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15
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Aksoy RA, Kaya V, Koca T, Korcum AF. The usefulness of the Geriatric-8 screening tool and basic laboratory parameters in older patients with non-small cell lung cancer. J Geriatr Oncol 2022; 13:1264-1267. [PMID: 35987893 DOI: 10.1016/j.jgo.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/13/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Rahmi Atil Aksoy
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey.
| | - Vildan Kaya
- Department of Radiation Oncology, Medstar Antalya Hospital, Antalya, Turkey; Antalya Bilim University, Antalya, Turkey
| | - Timur Koca
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Aylin Fidan Korcum
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
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16
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Komici K, Bencivenga L, Navani N, D'Agnano V, Guerra G, Bianco A, Rengo G, Perrotta F. Frailty in Patients With Lung Cancer: A Systematic Review and Meta-Analysis. Chest 2022; 162:485-497. [PMID: 35217002 DOI: 10.1016/j.chest.2022.02.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Previous studies regarding the prevalence of frailty in patients with lung cancer and mortality in frail patients with lung cancer are inconsistent and require clarification. RESEARCH QUESTION What is the prevalence and impact of frailty in patients with lung cancer? STUDY DESIGN AND METHODS This systematic review and meta-analysis used a combination of free-text terms and medical subject headings terms, according to the database requirements in MEDLINE/PubMed, Scopus, and Cochrane Library from inception until November 15, 2020. RESULTS A total of 2,571 articles were identified, and 16 articles involving 4,183 patients were included for study. The prevalence of frailty in lung cancer was 45% (95% CI, 28-61; I2 = 99.5%; P < .0001). In patients with lung cancer, frailty was associated with an increased hazard ratio for mortality (hazard ratio, 3.01; 95% CI, 1.77-5.10; P < .001). INTERPRETATION The prevalence of frailty in lung cancer is 45%, which has a significant negative impact on survival of patients with lung cancer. These results highlight the importance of measuring frailty, which provides important prognostic information, and may provide opportunities for interventions to improve outcomes in patients with lung cancer.
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Affiliation(s)
- Klara Komici
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy.
| | - Leonardo Bencivenga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II," Naples, Italy; Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, Toulouse, France
| | - Neal Navani
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, London, England; Department of Thoracic Medicine, University College London Hospital, London, England
| | - Vito D'Agnano
- Department of Translational Medicine, University of Campania "L. Vanvitelli," Naples, Italy
| | - Germano Guerra
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Bianco
- Department of Translational Medicine, University of Campania "L. Vanvitelli," Naples, Italy
| | - Giuseppe Rengo
- Istituti Clinici Scientifici ICS Maugeri-S.p.A.-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Scientifico di Telese Terme, Telese, Italy; Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Fabio Perrotta
- U.O.C. Pneumology A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy
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17
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Traunero F, Claps F, Silvestri T, Mir MC, Ongaro L, Rizzo M, Piasentin A, Liguori G, Vedovo F, Celia A, Trombetta C, Pavan N. Reliable Prediction of Post-Operative Complications' Rate Using the G8 Screening Tool: A Prospective Study on Elderly Patients Undergoing Surgery for Kidney Cancer. J Clin Med 2022; 11:jcm11133785. [PMID: 35807070 PMCID: PMC9267910 DOI: 10.3390/jcm11133785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 01/20/2023] Open
Abstract
In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients (≥70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery.
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Affiliation(s)
- Fabio Traunero
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
- Correspondence: ; Tel.: +39-040-399-4293
| | - Francesco Claps
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Tommaso Silvestri
- Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy; (T.S.); (A.C.)
| | - Maria Carmen Mir
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain;
| | - Luca Ongaro
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Michele Rizzo
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Andrea Piasentin
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Giovanni Liguori
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Francesca Vedovo
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy; (T.S.); (A.C.)
| | - Carlo Trombetta
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Nicola Pavan
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
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18
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Bandidwattanawong C, Kerkarchachai G. The benefits of G8 and VES-13 geriatric screening tools for older patients with advanced lung cancer. J Geriatr Oncol 2022; 13:1256-1259. [DOI: 10.1016/j.jgo.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/25/2022]
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Borghetti P, Guerini AE, Sangalli C, Piperno G, Franceschini D, La Mattina S, Arcangeli S, Filippi AR. Unmet needs in the management of unresectable stage III non-small cell lung cancer: a review after the 'Radio Talk' webinars. Expert Rev Anticancer Ther 2022; 22:549-559. [PMID: 35450510 DOI: 10.1080/14737140.2022.2069098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stage III non-small cell lung cancer (NSCLC) is a variable entity, encompassing bulky primary tumors, nodal involvement or both. Multidisciplinary evaluation is essential to discuss multiple treatment options, to outline optimal management and to examine the main debated topics and critical issues not addressed by current trials and guidelines that influence daily clinical practice. AREAS COVERED From March to May 2021, 5 meetings were scheduled in a webinar format titled 'Radio Talk' due to the COVID-19 pandemic; the faculty was composed of 6 radiation oncologists from 6 different Institutions of Italy, all of them were the referring radiation oncologist for lung cancer treatment at their respective departments and were or had been members of AIRO (Italian Association of Radiation Oncology) Thoracic Oncology Study Group. The topics covered included: pulmonary toxicity, cardiac toxicity, radiotherapy dose, fractionation and volumes, unfit/elderly patients, multidisciplinary management. EXPERT OPINION The debate was focused on the unmet needs triggered by case reports, personal experiences and questions; the answers were often not univocal, however, the exchange of opinion and the contribution of different centers confirmed the role of multidisciplinary management and the necessity that the most critical issues should be investigated in clinical trials.
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Affiliation(s)
- Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Andrea Emanuele Guerini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Claudia Sangalli
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaia Piperno
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Salvatore La Mattina
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Andrea Riccardo Filippi
- Department of Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
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Sekiguchi S, Tsuchiya K, Yasui Y, Inada K, Kirino S, Yamashita K, Hayakawa Y, Osawa L, Higuchi M, Takaura K, Maeyashiki C, Kaneko S, Tamaki N, Nakanishi H, Itakura J, Takahashi Y, Asahina Y, Okamoto R, Kurosaki M, Izumi N. Clinical usefulness of geriatric assessment in elderly patients with unresectable hepatocellular carcinoma receiving sorafenib or lenvatinib therapy. Cancer Rep (Hoboken) 2022; 5:e1613. [PMID: 35302279 PMCID: PMC9675392 DOI: 10.1002/cnr2.1613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/11/2022] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Therapeutic strategies for unresectable hepatocellular carcinoma (u-HCC) in geriatric patients are important for real-world practice. However, there remain no established biomarkers or therapeutic strategies regarding the best second-line agent after atezolizumab plus bevacizumab therapy. AIM In this study, we investigated the usefulness of modified Geriatric 8 (mG8) score in examining elderly patients (≥75 years old) with unresectable hepatocellular carcinoma (u-HCC) using sorafenib or lenvatinib as first-line therapy. METHODS AND RESULTS This study assessed 101 elderly patients with u-HCC for their mG8 score (excluding elements of age from 8 items) and classified them into 2 groups according to their mG8 score: ≥11 as the high-score group and ≤ 10 as the low-score group. Among those taking sorafenib, no significant differences were noted in overall survival (OS) and progression free survival (PFS) between low and high mG8 score groups. Only modified albumin-bilirubin (ALBI) grade (2b/3 vs. 1/2a: HR 0.34; 95% CI, 0.17-0.69; p = .0029) was significantly associated with OS. Among those taking lenvatinib, patients with a high mG8 score (n = 26) had longer survival than those with a low mG8 score (n = 10) (20.0 months vs. 7.7 months: HR 0.31, 95% CI 0.11-0.89; p = .029). Intrahepatic tumor volume (<50% vs. ≥50%: HR 16.7; 95% CI, 1.71-163; p = .016) and α-fetoprotein (AFP) (<400 vs. ≥400: HR 3.38; 95% CI 0.84-19.7; p = .031) remained significant factors independently associated with OS. CONCLUSIONS The mG8 score may contribute to making a decision when considering either sorafenib or lenvatinib as a treatment option for u-HCC in elderly patients.
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Affiliation(s)
- Shuhei Sekiguchi
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan,Department of Gastroenterology and HepatologyTokyo Medical Dental UniversityBunkyo‐KuJapan
| | - Kaoru Tsuchiya
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan
| | - Yutaka Yasui
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan
| | - Kento Inada
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan,Department of Gastroenterology and HepatologyTokyo Medical Dental UniversityBunkyo‐KuJapan
| | - Sakura Kirino
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan,Department of Gastroenterology and HepatologyTokyo Medical Dental UniversityBunkyo‐KuJapan
| | - Koji Yamashita
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan
| | - Yuka Hayakawa
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan,Department of Gastroenterology and HepatologyTokyo Medical Dental UniversityBunkyo‐KuJapan
| | - Leona Osawa
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan
| | - Mayu Higuchi
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan
| | - Kenta Takaura
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan
| | - Chiaki Maeyashiki
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan,Department of Gastroenterology and HepatologyTokyo Medical Dental UniversityBunkyo‐KuJapan
| | - Shun Kaneko
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan,Department of Gastroenterology and HepatologyTokyo Medical Dental UniversityBunkyo‐KuJapan
| | - Nobuharu Tamaki
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan,NAFLD Research Center, Department of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Hiroyuki Nakanishi
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan
| | - Jun Itakura
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan
| | - Yuka Takahashi
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan
| | - Yasuhiro Asahina
- Department of Gastroenterology and HepatologyTokyo Medical Dental UniversityBunkyo‐KuJapan
| | - Ryuichi Okamoto
- Department of Gastroenterology and HepatologyTokyo Medical Dental UniversityBunkyo‐KuJapan
| | - Masayuki Kurosaki
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan
| | - Namiki Izumi
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalMusashino‐shiJapan
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21
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Shah M, Noronha V, Ramaswamy A, Gattani S, Mokal S, Joshi A, Patil V, Menon N, Banavali S, Badwe R, Prabhash K. G8 and VES-13 as screening tools for geriatric assessment and predictors of survival in older Indian patients with cancer. J Geriatr Oncol 2022; 13:720-730. [DOI: 10.1016/j.jgo.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 12/29/2021] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
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22
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Hu W, Li B, Geng N, He X, Ge H, Wang P, Ding C. Association Between PDL1 Genetic Variation and Efficacy of Apatinib Monotherapy in Patients with Previously Treated Advanced NSCLC: A Real-World Retrospective Study. Int J Gen Med 2021; 14:2703-2714. [PMID: 34188525 PMCID: PMC8232958 DOI: 10.2147/ijgm.s303717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
Background This study aimed to explore associations between PDL1 polymorphisms and efficacy of apatinib for patients with previously treated advanced non-small cell lung cancer (NSCLC) in a real-world setting. Methods We retrospectively recruited 148 patients with previously treated advanced NSCLC from January 2015 to December 2019 continuously. Clinical efficacy in patients receiving apatinib treatment was evaluated. Adverse reactions were documented during treatment. Biological specimens of peripheral blood and cancer tissue biopsies were obtained for the genotyping of genetic variations in PDL1 and corresponding gene-mRNA expression, respectively. Univariate association analysis between the status of PDL1 genetic variations and survival was performed with Kaplan-Meier survival analysis. Results The objective response rate of the 148 patients was 17.6% and disease-control rate 68.9%. Prognostic data suggested that median progression-free survival (PFS) was 3.8 (95% CI 3.13-4.47) months and median overall survival (OS) 10.5 (95% CI 9.06-11.95) months. Regarding PDL1 genetic variation, only rs2297136 was of clinical significance. Prognosis analysis revealed that PFS and OS for the rs2297136 genotype were significantly different. Median PFS of patients with TC/CC and TT genotypes was 3 and 4.5 months, respectively (P=0.006). Median OS of the two genotypes was 9 and 11.6 months, respectively (P=0.04). Furthermore, the safety profile suggested that the most common adverse reactions were hypertension, dermal toxicity, fatigue, and oral toxicity. This study failed to find any significant association between adverse reactions and rs2297136. Interestingly, mRNA-expression analysis demonstrated that mRNA expression of PDL1 in biopsy cancer-tissue specimens was significantly different based on rs2297136-genotype status (P<0.001). Conclusion The PDL1 polymorphism rs2297136 could be used as a potential biomarker for the prognosis of patients with NSCLC receiving apatinib monotherapy.
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Affiliation(s)
- Wenxia Hu
- Department of Respiratory Medicine, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, People's Republic of China
| | - Bin Li
- Department of Respiratory Medicine, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, People's Republic of China
| | - Nan Geng
- Department of Respiratory Medicine, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, People's Republic of China
| | - Xin He
- Department of Respiratory Medicine, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, People's Republic of China
| | - Hui Ge
- Department of Respiratory Medicine, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, People's Republic of China
| | - Ping Wang
- Department of Respiratory Medicine, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, People's Republic of China
| | - Cuimin Ding
- Department of Respiratory Medicine, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, People's Republic of China
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Geng N, Su J, Liu Z, Ding C, Xie S, Hu W. The Influence of KDR Genetic Variation on the Efficacy and Safety of Patients With Advanced NSCLC Receiving First-Line Bevacizumab Plus Chemotherapy Regimen. Technol Cancer Res Treat 2021; 20:15330338211019433. [PMID: 34060368 PMCID: PMC8173991 DOI: 10.1177/15330338211019433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: Angiogenesis plays an important role in the growth and metastasis of non-small cell lung cancer (NSCLC). Bevacizumab is a humanized monoclonal antibody that mainly acts on vascular endothelial growth factor A (VEGFA). Kinase insert domain receptor (KDR) is the most important target of VEGFA. The aim of present study was to investigate the influence of KDR genetic variation on the efficacy and safety of patients with advanced NSCLC receiving first-line bevacizumab plus chemotherapy regimen. Methods: A total of 169 patients with advanced NSCLC who received bevacizumab combined with chemotherapy were recruited in this study. Clinical outcome of the regimens was evaluated in the hospital. Peripheral blood and biopsy tissue specimens of patients were collected for the genotyping of KDR genetic variation and KDR mRNA expression, respectively. The association between KDR genotype status and other variables were analyzed. Univariate analysis of genotype status and prognosis was implemented using the Kaplan-Meier survival analysis method. Multivariate Cox regression analysis was performed to adjust the confounding factors. Results: Of the polymorphisms analyzed, only V297 L was of clinical significance. The prevalence of V297 L among the study population were as follows: CC genotype 123 cases (72.8%), CT genotype 41 cases (24.3%), TT genotype 5 cases (2.9%). The minimum allele frequency is 0.15. The distribution frequencies of the 3 genotypes corresponded with Hardy-Weinberg equilibrium (P = 0.489). Patients with TT and CT genotypes were merged in the subsequent comparison of clinical outcomes. The analysis of efficacy exhibited that the objective response rates (ORR) of patients with CC genotype and CT/TT genotypes were 52.8% and 47.8% (P = 0.561), respectively. Prognosis indicated that the median progression free survival (PFS) of patients with CC genotype and CT/TT genotype were 8.9 and 5.5 months, respectively (P = 0.006). The median OS of the 2 genotypes were 20.0 and 14.9 months, respectively (P = 0.021). Adjusted in multivariate Cox regression analysis of PFS, CT/TT genotypes were an independent factor for PFS [hazard ratio (HR) = 1.59, P = 0.011). Safety profile according to genotype status of V297 L failed to find significant difference. Interestingly, the expression of KDR mRNA of patients with CT/TT genotype was significantly higher than that of patients with CC genotype in the 58 cancer tissue specimens (P < 0.001). Conclusion: The clinical comes of patients with advanced NSCLC receiving first-line bevacizumab plus chemotherapy regimens might be impacted by polymorphism V297 L through mediating the mRNA expression of KDR.
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Affiliation(s)
- Nan Geng
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Jingwei Su
- Department of Third Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Zhikun Liu
- Department of Radiotherapy, East Hospital of The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Cuimin Ding
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Shaonan Xie
- Department of Second Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Wenxia Hu
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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24
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Couderc AL, Gentile S, Nouguerède E, Celerien F, Moussaoui Z, Rey D, Barlesi F, Thomas PA, Greillier L, Villani P. Use and impact of the G8 score in older patients with thoracic and lung cancers. Eur Geriatr Med 2021; 12:1095-1100. [PMID: 34003483 DOI: 10.1007/s41999-021-00510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Assessment of vulnerability with the G8 screening tool according to cancer localization and weight of the G8 items when screening frailty in thoracic and lung cancer (TLC) compared to other cancer localizations. METHODS This study was conducted retrospectively on all G8 data collected for older cancer patients between April 2015 and December 2019 at Marseille University Hospital. RESULTS One thousand four hundred and thirty-one patients were included; the median age was 80.6 years and 62.3% of the patients were men. The most common type of cancer was thoracic cancer (34.5%). A majority of patients with thoracic cancers (74.4%) had an impaired G8. In a logistic regression model, male gender, age < 80 years, BMI < 23 kg/m2, normal psychological status, and health status perception were independent factors associated with thoracic cancers. CONCLUSION Improving nutritional status and maintaining mental health are important issues to consider before treatment initiation in older patients with thoracic cancers.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine, Geriatrics and Therapeutic Unit, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France. .,Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France. .,Aix-Marseille University, CNRS, EFS, ADES, Marseille, France.
| | - Stéphanie Gentile
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Emilie Nouguerède
- Internal Medicine, Geriatrics and Therapeutic Unit, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France.,Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France
| | | | | | - Dominique Rey
- Internal Medicine, Geriatrics and Therapeutic Unit, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France.,Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France
| | - Fabrice Barlesi
- Gustave Roussy Cancer Campus, Villejuif, France.,Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Pascal-Alexandre Thomas
- Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France.,Thoracic Surgery Unit, AP-HM, Marseille, France
| | - Laurent Greillier
- Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France.,Multidisciplinary Oncology and Therapeutic Innovations Department, AP-HM, Marseille, France
| | - Patrick Villani
- Internal Medicine, Geriatrics and Therapeutic Unit, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France.,Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France.,Aix-Marseille University, CNRS, EFS, ADES, Marseille, France
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Nakazawa J, Kawahira M, Kawahira M, Kodama T, Arima S, Iwashita Y, Mawatari S, Hashimoto S, Kanmura S, Hori T, Tsubouchi H, Ido A. Analysis of factors affecting progression-free survival of first-line chemotherapy in older patients with advanced gastrointestinal cancer. J Geriatr Oncol 2021; 12:1200-1207. [PMID: 33994149 DOI: 10.1016/j.jgo.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/16/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Few studies have investigated factors influencing the efficacy of chemotherapy in older patients with cancer. This study aimed to evaluate the usefulness of G8, geriatric assessment (GA), and factors measured in general clinical practice for evaluating progression-free survival (PFS) of first-line palliative chemotherapy in older patients with advanced gastrointestinal cancer. MATERIALS AND METHODS This was a prospective observational study of older patients (age ≥ 70 years) with advanced gastrointestinal cancer. The modified cut-off value of G8 was determined by referring to two or more abnormal GA conditions. The usefulness of baseline GA and G8 (conventional and modified cut-off value) was assessed according to the efficacy (PFS and disease control rate) of the administered first-line palliative chemotherapy. RESULTS Overall, 93 patients were evaluated between March 2017 and February 2019. A modified G8 cut-off value of ≤12 had a sensitivity and specificity of 68.9% and 46.9%, respectively. PFS was significantly prolonged in the patients with G8 > 12, serum albumin ≥3.5 g/dl, and in whom grade ≥ 3 adverse events occurred. There was no significant difference in the PFS between monotherapy and combination therapy. GA was not useful for predicting PFS prolongation or the occurrence of serious adverse events in first-line treatment. CONCLUSION Among older patients with advanced gastrointestinal cancer who receive first-line chemotherapy, a modified G8 cut-off value of 12 points, occurrence of grade 3 or higher adverse events, albumin levels, rather than age or performance status were predictors of PFS prolongation.
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Affiliation(s)
- Junichi Nakazawa
- Department of Medical Oncology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima city, Kagoshima 890-8760, Japan.
| | - Machiko Kawahira
- Department of Medical Oncology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima city, Kagoshima 890-8760, Japan; Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima city, Kagoshima 890-8520, Japan.
| | - Masahiro Kawahira
- Department of Medical Oncology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima city, Kagoshima 890-8760, Japan.
| | - Tomoko Kodama
- Department of Medical Oncology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima city, Kagoshima 890-8760, Japan.
| | - Shiho Arima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima city, Kagoshima 890-8520, Japan.
| | - Yuji Iwashita
- Department of Gastroenterology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima city, Kagoshima 890-8760, Japan.
| | - Seiji Mawatari
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima city, Kagoshima 890-8520, Japan.
| | - Shinichi Hashimoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima city, Kagoshima 890-8520, Japan.
| | - Shuji Kanmura
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima city, Kagoshima 890-8520, Japan.
| | - Takeshi Hori
- Department of Gastroenterology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima city, Kagoshima 890-8760, Japan.
| | - Hirohito Tsubouchi
- Department of Gastroenterology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima city, Kagoshima 890-8760, Japan.
| | - Akio Ido
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima city, Kagoshima 890-8520, Japan.
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26
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Couderc AL, Tomasini P, Nouguerède E, Rey D, Correard F, Montegut C, Thomas PA, Villani P, Barlesi F, Greillier L. Older Patients Treated for Lung and Thoracic Cancers: Unplanned Hospitalizations and Overall Survival. Clin Lung Cancer 2021; 22:e405-e414. [DOI: 10.1016/j.cllc.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 02/01/2023]
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Lewis ET, Harrison R, Nicholson M, Hillman K, Trankle S, Rangel S, Stokes C, Cardona M. Clinicians' and public acceptability of universal risk-of-death screening for older people in routine clinical practice in Australia: cross-sectional surveys. Aging Clin Exp Res 2021; 33:1063-1070. [PMID: 32458357 DOI: 10.1007/s40520-020-01598-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Clinicians' delays to identify risk of death and communicate it to patients nearing the end of life contribute to health-related harm in health services worldwide. This study sought to ascertain doctors, nurses and senior members of the public's perceptions of the routine use of a screening tool to predict risk of death for older people. METHODS Cross-sectional online, face-to-face and postal survey of 360 clinicians and 497 members of the public. RESULTS Most (65.9%) of the members of the public welcomed (and 12.3% were indifferent to) the use of a screening tool as a decision guide to minimise overtreatment and errors from clinician assumptions. Supporters of the use of a prognostic tool were likely to be males with high social capital, chronically ill and who did not have an advance health directive. The majority of clinicians (75.6%) reported they were likely or very likely to use the tool, or might consider using it if convinced of its accuracy. A minority (13.3%) stated they preferred to rely on their clinical judgement and would be unlikely to use it. Differentials in support for tools by seniority were observed, with more support expressed by nurses, interns and registrars than medical specialists (χ2 = 12.95, p = 0.044) and by younger (< 40 years) clinicians (81.2% vs. 71.2%, p = 0.0058). DISCUSSION The concept of integrating prognostication of death in routine practice was not resisted by either target group. CONCLUSION Findings indicate that screening for risk of death is seen as potentially useful and suggests the readiness for a culture change. Future research on implementation strategies could be a step in the right direction.
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Use of the Geriatric-8 screening tool to predict prognosis and complications in older adults with head and neck cancer: A prospective, observational study. J Geriatr Oncol 2021; 12:1039-1043. [PMID: 33757718 DOI: 10.1016/j.jgo.2021.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/12/2021] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To clarify the usefulness of geriatric assessment screening tools for predicting prognosis and complications in older adults with head and neck cancer (HNC). MATERIAL AND METHODS The geriatric-8 (G8) screening tool was administered to 78 older adults with HNC at their first visit to the hospital before any treatments. The ability of the G8 to predict survival was evaluated by receiver operating characteristic (ROC) curve analysis and determining the cut-off value using Youden's Index. The G8 and other factors related to prognosis (age, performance status (PS), Charlson comorbidity index, number of oral medicines (polypharmacy), the controlling nutritional status (CONUT) score for biological nutrition status, and treatment intent (curative or palliative)) were validated by Cox proportional hazards regression analysis. The survival analysis was validated in a propensity score-weighting cohort to correct for confounding factors. Correlations between these factors and complications were examined using Fishers exact test. RESULTS The G8 cut-off value for overall survival was 10.5 (area under the curve (AUC) 0.69; 95% confidence interval (CI) 0.56-0.82). In the propensity score-weighted cohort, on Cox proportional hazards regression analysis, the hazard ratio of an abnormal G8 (<11) was 3.70 [1.59-8.61 (p = 0.002)], and the hazard ratio of PS-abnormal (≥2) was 0.85 [0.09-7.60 (p = 0.88)]. Thirty-day mortality and all-complication rates were significantly higher in the G8-abnormal group. Neither major complications nor transfer to other institutions was correlated with an abnormal G8. CONCLUSION The G8 was a strong prognostic factor and a possible predictor of complications in older adults with HNC.
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Jespersen E, Winther SB, Minet LR, Möller S, Pfeiffer P. Frailty screening for predicting rapid functional decline, rapid progressive disease, and shorter overall survival in older patients with gastrointestinal cancer receiving palliative chemotherapy - a prospective, clinical study. J Geriatr Oncol 2020; 12:578-584. [PMID: 33830020 DOI: 10.1016/j.jgo.2020.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/11/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES A growing number of older patients with cancer require well-founded clinical decision-making. Frailty screening is suggested as a service to improve outcomes in vulnerable older patients with cancer. This prospective study examined the value of frailty screening to predict rapid functional decline, rapid progressive disease (PD) and shorter overall survival (OS) in older patients with gastrointestinal cancer receiving palliative chemotherapy. MATERIALS AND METHODS Patients aged ≥70 years were screened for frailty in an oncologic department after clinical decision but before starting palliative chemotherapy. Screening was repeated at first response evaluation after approximately two months of chemotherapy. Frailty screening tools included performance status (PS), Charlson Comorbidity Index, G-8 using two different cut-offs (G814,G811), VES-13, Timed-Up-and-Go, Handgrip strength and falls. RESULTS A total of 170 patients were included, median age was 75.5 (70-88) years and 65.9% were male. The frequency of frailty varied from 14% to 74% according to the chosen frailty tool. In multivariate analysis G814 predicted OS (HR 1.5; 95%CI 1.0-2.4), whereas G811 predicted PD (OR 2.4; 1.1-5.6) and OS (HR 2.1; 1.4-2.9). VES-13 predicted functional decline (OR 3.5; 1.0-11.6), PD (OR 3.5; 1.5-8.4) and OS (HR 1.7; 1.2-2.4). Timed-Up-and-Go predicted OS (HR 1.8; 1.1-2.7). Handgrip strength and falls predicted functional decline (OR 4.5; 1.1-19 and OR 6.1; 1.4-25.8, respectively). PS predicted PD (OR 6.2; 2.6-14.7) and OS (HR 2.2; 1.5-3.2). CONCLUSION VES-13 was useful for predicting all three endpoints of interest. Frailty tools covering domains of functioning and nutrition are suggested for older patients with advanced gastrointestinal cancer.
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Affiliation(s)
- Eva Jespersen
- Research Unit of Rehabilitation, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Stine Braendegaard Winther
- Department of Oncology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lisbeth Rosenbek Minet
- Research Unit of Rehabilitation, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Health Science Research Centre, UCL University College, Odense, Denmark
| | - Sören Möller
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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Yan Z, Gu YY, Hu XD, Zhao Q, Kang HL, Wang M, Duan W, Guan Y. Clinical outcomes and safety of apatinib monotherapy in the treatment of patients with advanced epithelial ovarian carcinoma who progressed after standard regimens and the analysis of the VEGFR2 polymorphism. Oncol Lett 2020; 20:3035-3045. [PMID: 32782621 DOI: 10.3892/ol.2020.11857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/05/2020] [Indexed: 12/30/2022] Open
Abstract
The aims of the present study were to investigate the clinical outcomes and safety of apatinib monotherapy in the treatment of patients with advanced epithelial ovarian carcinoma (EOC) who have progressed after standard regimens, and to analyze the vascular endothelial growth factor receptor 2 (VEGFR2) rs2071559 polymorphism. A total of 118 patients with advanced EOC who received apatinib treatment were included in the study. Tumor response was evaluated using progression-free survival (PFS) and overall survival (OS) time, and safety data were documented. Additionally, peripheral blood and peripheral blood mononuclear cell (PBMC) specimens from the patients with EOC were collected to perform the genotyping of genetic polymorphism and assess the mRNA expression of VEGFR2, respectively. The objective response rate across the 118 patients with advanced EOC was 38.98%, the disease control rate was 63.56%, the median PFS time was 4.65 months and the median OS time was 15.10 months. Regarding the polymorphism analysis, the prevalence of rs2071559 in VEGFR2 among the 118 patients with advanced EOC was recorded as the TT genotype in 72 cases (61.02%), TC genotype in 41 cases (34.75%) and CC genotype in 5 cases (4.23%), and the minor allele frequency of rs2071559 was 0.22. The distribution of the three genotypes was in accordance with the Hardy-Weinberg equilibrium (P=0.781). TC and CC genotypes were merged in the subsequent analysis. The prognosis analyses suggested that the median PFS time of patients with the TC/CC genotype and the TT genotype was 3.10 and 5.40 months, respectively (P=0.015). Moreover, the median OS time of the two genotypes was 12.60 and 17.50 months, respectively (P=0.009). However, no association was noted between genotype status of the polymorphism and adverse reactions. Additionally, the mRNA expression analysis indicated that the mRNA expression levels of VEGFR2 in PBMC specimens were significantly different between TT and TC/CC genotypes (P<0.001). The present study suggested that the clinical outcomes of patients with advanced EOC, who progressed after standard regimens and received apatinib treatment, might be influenced by the VEGFR2 rs2071559 polymorphism.
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Affiliation(s)
- Zhen Yan
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Yuan-Yuan Gu
- Department of Oncology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xiao-Di Hu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Qun Zhao
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Hai-Li Kang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Miao Wang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Wei Duan
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Yin Guan
- Department of Oncology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
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The prognostic value of patient-reported Health-Related Quality of Life and Geriatric Assessment in predicting early death in 6769 older (≥70 years) patients with different cancer tumors. J Geriatr Oncol 2020; 11:926-936. [DOI: 10.1016/j.jgo.2020.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/12/2020] [Accepted: 03/26/2020] [Indexed: 01/10/2023]
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Gogineni E, Rana Z, Wotman M, Karten J, Riegel A, Marrero M, Maduro L, Kamdar D, Frank D, Paul D, Seetharamu N, Ghaly M. Impact of stereotactic body radiation therapy on geriatric assessment and management for older patients with head and neck cancer using G8. J Geriatr Oncol 2020; 12:122-127. [PMID: 32593669 DOI: 10.1016/j.jgo.2020.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/11/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Management of head and neck cancers (HNC) in older adults is a common but challenging clinical scenario. We assess the impact of Stereotactic Body Radiation Therapy (SBRT) on survival utilizing the Geriatric-8 (G8) questionnaire. MATERIALS AND METHODS 171 HNC patients, deemed medically unfit for definitive treatment, were treated with SBRT ± systemic therapy. G8 questionnaires were collected at baseline, at 4-6 weeks, and at 2-3 months post-treatment. Patients were stratified according to their baseline G8 score: <11 as 'vulnerable', 11-14 as 'intermediate', and >14 as 'fit'. Overall survival (OS) was assessed through univariate Kaplan Meier analysis. Repeated measures ANOVA was used to determine if baseline characteristics affected G8 score changes. RESULTS Median follow-up was seventeen months. 60% of patients presented with recurrent HNC, 30% with untreated HNC primaries, and 10% with metastatic non-HNC primaries. Median age was 75 years. Median Charlson Comorbidity Index score was 2. 51% of patients were 'vulnerable', 37% were 'intermediate', and 12% were 'fit' at baseline, with median survival of 13.2, 24.3, and 41.0 months, respectively (p = .004). Patients who saw a decrease in their follow-up G8 score (n = 69) had significantly lower survival than patients who had stable or increased follow-up G8 scores (n = 102), with median survival of 8.6 vs 36.0 months (p < .001). CONCLUSION The G8 questionnaire may be a useful tool in upfront treatment decision-making to predict prognosis and prevent older patients from receiving inappropriate anti-cancer treatment. Decline in follow-up G8 scores may also predict worse survival and aid in goals of care following treatment.
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Affiliation(s)
- Emile Gogineni
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Zaker Rana
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Michael Wotman
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Jessie Karten
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Adam Riegel
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Mihaela Marrero
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Luis Maduro
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Dev Kamdar
- Department of Otolarygology, Head / Neck Surgery, Northwell Health, Lake Success, NY, USA
| | - Douglas Frank
- Department of Otolarygology, Head / Neck Surgery, Northwell Health, Lake Success, NY, USA
| | - Doru Paul
- Department of Medical Oncology, Northwell Health, Lake Success, NY, USA
| | | | - Maged Ghaly
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA.
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Liu JY, Zhu BR, Wang YD, Sun X. The efficacy and safety of Apatinib mesylate in the treatment of metastatic osteosarcoma patients who progressed after standard therapy and the VEGFR2 gene polymorphism analysis. Int J Clin Oncol 2020; 25:1195-1205. [PMID: 32215805 DOI: 10.1007/s10147-020-01644-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/28/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the efficacy and safety of Apatinib mesylate in the treatment of metastatic osteosarcoma patients who progressed after standard therapy and the VEGFR2 gene polymorphism analysis. METHODS Designed as a retrospective study, a total of 105 metastatic osteosarcoma patients who progressed after standard therapy were included in this study. The metastatic osteosarcoma patients received 500-750 mg Apatinib mesylate according to body surface area until disease progression or unacceptable toxicity with 28 days one cycle. Overall response was evaluated after two cycles Apatinib treatment, then progression-free survival (PFS) and overall survival (OS) were evaluated, and safety data were recorded. Additionally. peripheral blood and peripheral blood mononuclear cell (PBMC) specimens in the osteosarcoma patients were collected for the genotyping of VEGFR2 genetic variation and mRNA expression, respectively. Analysis on the association between genotype and baseline characteristics and VEGFR2 gene mRNA expression was analyzed. The univariate analysis of genotypes and prognosis was carried out by Kaplan-Meier survival analysis, and multivariate analysis was adjusted by Cox regression analysis. RESULTS The objective response rate (ORR) of the 105 metastatic osteosarcoma patients was 37.14%, disease control rate (DCR) was 77.14%, median PFS was 4.1 months, and median OS was 9.0 months. Regarding the VEGFR2 gene polymorphisms analysis, only - 906 T > C was of clinical significance. The prevalence of - 906 T > C in VEGFR2 among the study population was as follows: TT genotype 62 cases (59.05%), TC genotype 36 cases (34.29%) and CC genotype 7 cases (6.66%), minor allele frequency of - 906 T > C was 0.24. Compared with patients with TC/CC genotype, patients with TT genotype showed longer median PFS (5.0 versus 3.1 months, P = 0.011) and median OS (9.8 versus 7.6 months, P = 0.032). There was no correlation between the polymorphism and adverse reactions. Additionally, the mRNA expression in 69 randomly selected sample indicated that the mRNA expression of VEGFR2 of the patients with CC/TC genotypes were significantly higher than those of the TT genotype patients (P < 0.001). CONCLUSION Apatinib was safe and effective in the treatment of metastatic osteosarcoma patients who progressed after standard therapy. The clinical outcomes of Apatinib may be influenced by the polymorphism - 906 T > C of VEGFR2 through mediating the mRNA expression of VEGFR2.
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Affiliation(s)
- Jia-Yong Liu
- Department of Bone and Soft Tissue Tumor, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, 100142, P. R. China.
| | - Bao-Rang Zhu
- Department of Tumor Minimally Invasive Treatment, The Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of the PLA), Beijing, 100071, P. R. China
| | - Yu-Dong Wang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, P. R. China
| | - Xin Sun
- Department of Orthopedic Oncology, Peking University People's Hospital, Beijing, 100044, P. R. China.
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Song ZZ, Zhao LF, Zuo J, Fan ZS, Wang L, Wang YD. Clinical Outcomes and Safety of Apatinib Mesylate in the Treatment of Advanced Non-Squamous Non-Small Cell Lung Cancer in Patients Who Progressed After Standard Therapy and Analysis of the KDR Gene Polymorphism. Onco Targets Ther 2020; 13:603-613. [PMID: 32021302 PMCID: PMC6982468 DOI: 10.2147/ott.s222985] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose This study investigated the clinical outcomes and safety of apatinib mesylate in the treatment of advanced non-squamous non-small cell lung cancer (NSCLC) in patients who progressed after standard therapy, and analyzed the kinase insert domain receptor (KDR) gene polymorphism. Methods A total of 135 patients with advanced non-squamous NSCLC who received apatinib mesylate were included. Objective response rates were evaluated. Subsequently, progression-free survival (PFS) and overall survival (OS) were assessed and safety data were recorded. Additionally, peripheral blood and biopsy cancer tissue specimens were collected from the patients with NSCLC for the genotyping of the genetic polymorphism and mRNA expression of the KDR gene, respectively. Analysis on the association between genotypes and prognosis was conducted. Results The objective response rate of the 135 patients with NSCLC was 18.52%, disease control rate was 65.19%, median PFS was 3.95 months, and median OS was 10.05 months. Regarding the KDR gene polymorphism analysis, the distribution of the 4397T>C polymorphism genotypes was in accordance with the Hardy–Weinberg Equilibrium (P=0.868). Moreover, the prognosis analysis indicated that the median PFS of patients with the CC/TC and TT genotypes was 2.80 and 4.80 months, respectively (P=0.002). Furthermore, the median OS of patients with the two genotypes was 9.10 and 10.56 months, respectively (P=0.041). The multivariate Cox regression analysis showed that the TC/CC genotypes were an independent factor for PFS (odds ratio: 1.72, P=0.009). There was no correlation between the polymorphism and adverse reactions. Additionally, the mRNA expression analysis suggested that the mRNA levels of KDR in cancer tissues were significantly different between the TT and TC/CC genotypes (P<0.001). Conclusion The clinical outcomes of treatment with apatinib mesylate for advanced non-squamous NSCLC in patients who progressed after standard therapy may be influenced by the KDR 4397T>C polymorphism through mediation of the mRNA expression of KDR.
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Affiliation(s)
- Zi-Zheng Song
- Department of Medical Oncology, The Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Li-Fen Zhao
- Department of Respiratory and Critical Care Medicine, The Shanxi Dayi Hospital, Taiyuan, People's Republic of China
| | - Jing Zuo
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Zhi-Song Fan
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Long Wang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yu-Dong Wang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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Prabhash K, Noronha V, Ramaswamy A, Dhekle R, Talreja V, Gota V, Gawit K, Krishnamurthy M, Patil V, Joshi A, Menon N, Kapoor A, Sekar A, Shah D, Ostwal V, Banavali S. Initial experience of a geriatric oncology clinic in a tertiary cancer center in India. CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_119_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Loh KP, Duberstein P, Zittel J, Lei L, Culakova E, Xu H, Plumb S, Flannery MA, Magnuson A, Bautista J, Wittink M, Gilmore N, Targia V, Conlin A, Berenberg J, Vogel VG, Mohile SG. Relationships of self-perceived age with geriatric assessment domains in older adults with cancer. J Geriatr Oncol 2019; 11:1006-1010. [PMID: 31899198 DOI: 10.1016/j.jgo.2019.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/22/2019] [Accepted: 12/26/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Older self-perceived age is associated with poor health and higher healthcare utilization in the geriatric population. We evaluated the associations of self-perceived age with geriatric assessment (GA) domain impairments in older adults with cancer. METHODS This was a secondary analysis of baseline data from a GA cluster-randomized trial (URCC 13070; PI: Mohile). We included patients aged ≥70 with incurable stage III/IV solid tumor or lymphoma considering or receiving treatment and had ≥1 GA domain impairment other than polypharmacy. Multivariate analyses were used to evaluate the associations of age difference between chronological and self-perceived age (categorized into "feeling younger than chronological age" vs. "feeling the same or older than their chronological age") with GA domain impairments. RESULTS We included 533 patients; mean age was 76.6 (SD 5.2). On multivariate analyses, compared to those who felt younger than their chronological age, those who felt the same or older were more likely to have impairments in physical performance [Adjusted Odds Ratio (AOR) 5.42, 95% Confidence Interval (CI) 1.69-17.40)], functional status (AOR 2.31, 95% CI 1.73-3.07), comorbidity (AOR 1.62, 95% CI 1.20-2.19), psychological health (AOR 2.62, 95% CI 1.85-3.73), and nutrition (AOR 1.65, 95% CI 1.20-2.28). They were also more likely to screen positively for polypharmacy (AOR 1.86, 95% CI 1.30-2.65). CONCLUSIONS Older adults with cancer who felt the same or older than their chronological age were more likely to have GA domain impairments. Further studies are needed to better understand the relationships between self-perceived age, aging-related conditions, and outcomes in this population.
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Affiliation(s)
- Kah Poh Loh
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Paul Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, New Brunswick, NJ, USA.
| | - Jason Zittel
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Lianlian Lei
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Eva Culakova
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Huiwen Xu
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Sandy Plumb
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Marie A Flannery
- School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Allison Magnuson
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Javier Bautista
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Marsha Wittink
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Nikesha Gilmore
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Valerie Targia
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Alison Conlin
- Pacific Cancer Research Consortium National Cancer Institute Community Oncology Research Program (NCORP), Seattle, WA, USA.
| | - Jeffrey Berenberg
- Hawaii National Cancer Institute Community Oncology Research Program (MU-NCORP), Honolulu, HI, USA.
| | | | - Supriya G Mohile
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Friedlaender A, Banna GL, Buffoni L, Addeo A. Poor-Performance Status Assessment of Patients with Non-small Cell Lung Cancer Remains Vague and Blurred in the Immunotherapy Era. Curr Oncol Rep 2019; 21:107. [PMID: 31768759 DOI: 10.1007/s11912-019-0852-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW In the latest decade, the introduction of immune-checkpoint inhibitors (ICIs) has dramatically improved the prognosis of patients with NSCLC. First-line ICIs or chemo-ICI trials have demonstrated OS advantages but the accrual was limited to Eastern Cooperative Oncology Group (ECOG) performance status (PS)0-1 patients. ICI studies have for the vast majority excluded patients with poor performance status. PS 2 particularly is known as a negative prognostic factor for survival and a predictive factor of adverse events and poor response to treatments. Data on the activity of ICIs in PS2 patients are limited and come from heterogeneous meta-analyses and small phase II or expanded access trials. Often, terms such as "unfit" or "frail" ascertain the eligibility of patients to undergo cytotoxic chemotherapy, without specifying PS. RECENT FINDINGS Other tools exist to aid in decision-making, and one simple, rapid, and validated screening test for frailty is the FRAIL scale consisting of 5 straightforward questions that can be self-administered and may represent an efficient and cost-effective way to screen large groups of patients for frailty. The Comprehensive Geriatric Assessment (CGA) is a widely used method to determine the medical, psychological, and functional capabilities of older patients. However, CGA is time-consuming and this could represent a real barrier to its adoption in clinical practice. For this reason, a quick screening tool, the G8 questionnaire, has been developed and demonstrated validity also in a younger population. A complementary tool to assess patients' frailty is Charlson comorbidity index (CCI) which has become the most widely used clinical index for a variety of disorders and cancers. Yet, none of these tools has been validated as predictive in ICI. In conclusion, solid data regarding the benefit of ICIs in ECOG PS2 NSCLC patients are currently lacking and the role of immunotherapy remains uncertain for PS2 patients. Prospective randomized trials addressing this question are warranted or ongoing. However, we are concerned that without a more extensive and objective assessment of patients' fitness and frailty by using and validating appropriate tools a clear answer may not come to light.
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Affiliation(s)
- Alex Friedlaender
- Oncology Department, Geneva University Hospital, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | | | - Lucio Buffoni
- Oncology Department, San Luigi Hospital University of Turin, Orbassano, Turin, Italy
| | - Alfredo Addeo
- Oncology Department, Geneva University Hospital, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
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