Filgrastim prophylaxis in elderly cancer patients in the real-life setting: a French multicenter observational study, the TULIP study

Purpose

Few studies are currently available among elderly patients, justifying the need for better understanding of daily medical practices in terms of use of growth factors to prevent chemotherapy (CT)-induced neutropenia. The primary objective of this study was to describe the use of filgrastim in the elderly.

Methods

Cancer patients aged 65 years and above, undergoing CT and initiating a prophylactic treatment with filgrastim, were enrolled. Patients were followed according to routine medical practice from filgrastim initiation until the end of the CT or after a maximum of 6 cycles.

Results

One thousand one hundred nineteen evaluable patients were documented in the study (mean age 73.9 ± 6.2 years, 52.1% men). The majority were suffering from solid tumor (73%) with ECOG 0–1 for 80% of them. Approximately two-third had a global risk for FN ≥ 20%, and one third < 20%. Through all CT cycles, no differences were observed between age classes ([65–74], [75–85], or > 85) in dose, duration, and time to first injection from CT start. Most patients (84%) received primary prophylaxis (PP) and 70% were administered during the first CT cycle. The median time from CT start until filgrastim was 4 days. The median duration of filgrastim treatment was 5 days. Dose reductions and CT delays were less frequent in patients receiving PP (4.8% and 7.1% respectively) than secondary prophylaxis (9.2% and 13.3% respectively).

Conclusions

Filgrastim use was consistent with French Market Authorization terms. No difference was shown compared with younger patients. Safety data were consistent with the known safety profile.

Electronic supplementary material

The online version of this article (10.1007/s00520-019-04725-0) contains supplementary material, which is available to authorized users.

Age-related socio-economic and geographic disparities in breast cancer stage at diagnosis: a population-based study

BACKGROUND

This study aimed to determine the impact of socio-economic and geographic disparities on disease stage at diagnosis according to age in breast cancer (BC) patients. Secondary purpose was to describe survival

METHODS

All women with primary invasive BC, diagnosed from 1998 to 2009 in the department of Côte d'Or were retrospectively selected using data from the Côte d'Or BC registry. European transnational ecological deprivation index (French European Deprivation Index) was used to measure the socio-economic environment. Relationships between socio-geographic deprivation and disease stage at diagnosis according to age were assessed by a multilevel ordered logistic regression model. Relative survival rates (RSRs) were given at 5 years according to tumour and patients characteristics.

RESULTS

In total, 4364 women were included. In multivariable analysis, socio-economic deprivation was associated with disease stage at diagnosis. Women aged between 50 and 74 years and living in deprived areas were more often diagnosed with advanced tumour stages (stages II/III vs. I or stages IV vs. II/III) with odds ratio = 1.27 (1.01-1.60). RSRs were lowest in women living in the most deprived area compared with those living in most affluent area with RSR = 88.4% (85.9-90.4) and 92.6% (90.5-94.2), respectively.

CONCLUSIONS

Socio-economic factors affected tumour stage at diagnosis and survival. Living in a deprived area was linked to advanced-stage BC at diagnosis only in women aged 50-74 years. This is probably due to the socio-economic disparities in participation in organized BC screening programmes. Furthermore, living in deprived area was associated with a poor survival rate.

Changes in the practice of adjuvant radiotherapy in resectable rectal cancer within a French well-defined population

BACKGROUND AND PURPOSE

To assess the use of adjuvant radiotherapy in treating rectal cancers at a population level.

MATERIALS AND METHODS

From 1976 to 1996, the influence of the period of diagnosis, sex, age, type of surgical resection, place of surgical resection on the use of radiotherapy was studied. A non-conditional logistic regression was performed to obtain the odds radio for each studied period adjusted for the other variables.

RESULTS

The use of adjuvant radiotherapy increased over time from 14.3% in 1976-1978 to 61.7% in 1994-1996 (odds ratio (OR): 28.0 for the 1994-1996 period compared with 1976-1978). It was also influenced by age (OR: 0.26 for patients >74 years compared with those <65 years), type of resection (OR: 3.42 for abdominoperineal resection compared with anterior resection) and place of surgery (OR: 0.39 for non-university hospitals compared with university hospitals). The nature of adjuvant radiotherapy altered over time: most adjuvant radiotherapy being done postoperatively before 1988, then preoperatively subsequently.

CONCLUSIONS

Substantial changes have occurred in both the degree of use of adjuvant radiotherapy and in its timing. Some progress is still possible, in particular in older patients and in patients treated in non-university hospitals.

Survival rates of malignant gliomas in Burgundy from 1990 to 1995

The aim of this study was to provide current data on case-fatality rates of malignant gliomas in the area of Burgundy (1,300,000 inhabitants). The ascertainment was specific according to imaging and histologic criteria, and was exhaustive because of the existence of a single University Hospital allowing both imaging and histologic diagnosis from stereotaxic cerebral biopsy. During six full years we collected 161 cases of malignant gliomas grades II to IV, 93 men (57.76%) and 68 women (42.23%). The mean age was 61 years. In all the age groups, there were a male predominance. Headache, epilepsy and motor deficit were the most frequent symptoms at onset. In most cases, the gliomas were localized within the frontal area. The post-surgical Karnofsky score was up to 70 in 40% of the cases. There were 89 glioblastomas with grade IV, 37 anaplastic astrocytomas, 13 gliomatous tumors with grade II and IV and six anaplastic oligodendrogliomas. This grading explains the very low survival rates, with a negative effect induced by age. Among the most relevant contributions of this study to the clinical features of malignant gliomas is an analysis of case-fatality rates, evaluation of health care services and therapeutic trials.

[Cisplatin, 5-FU and preoperative radiotherapy in esophageal epidermoid cancer. Multicenter phase II FFCD 8804 study]

OBJECTIVES

The aim of this study was to analyze the efficacy and tolerance of preoperative radiochemotherapy in esophageal squamous cell carcinoma. Patterns of recurrence and prognostic factors were also studied.

PATIENTS AND METHODS

This multicentric phase II trial included patients deemed operable. Preoperative treatment associated 5-FU 800 mg/m2/d by continuous infusion, cisplatin 20 mg/m2/d and radiotherapy 3 Gy/d D 1-5 and D 22-26. Resection was planned 50 to 60 days after the beginning of therapy.

RESULTS

Seventeen centers accrued 96 patients, mean age 55.4 years. According to UICC 1978 classification: stage I 13%, stage II 53% and stage III 30%. Mean follow-up was 73 months. Pre-operative treatment was delivered at full dose in half of the patients. Ten percent of the patients did not receive the second cycle. Toxicity reached grade 3 in 23% and grade 4 in 7% of the patients. Two preoperative deaths occurred. Curative resection was performed in 82% of the patients. Operative mortality was 9%. tumors were sterilized on the operative specimen in 20% of the patients and microscopic remnants were observed in 13%. Preoperative clinical work-up overestimated histologic response in 10% of the cases underestimated it in 29%. After 2 years, a recurrence was observed in 56% of the patients: loco-regional in 30%, metastases in 19% and both in 7%. Median survival was 17 months and survival rates were 58% at 1 year and 25% at 5 years. Four prognostic factors influenced survival in multivariate analysis (Cox model): hematological toxicity grade 3 or 4, no complete response, circumferential extension > 2/3 and nodes visible on CT-scan. Factors positively influencing complete response were in multivariate analysis: a fungating tumor, weight loss < 8% and a full dose preoperative treatment.

CONCLUSION

In this study, preoperative treatment associating 5-FU-cisplatin and radiotherapy allowed a high resectability rate, with one third of patients achieving complete or nearly complete histologic response. A randomized study is warranted to know whether this combined treatment is better than surgery alone.

[Determining factors for adjuvant treatment of breast cancer in the Côte d'Or region 1982-1990. Registry of gynecologic cancers at the Côte d'Or]

In the search for changing medical practices, this population-based study dealt with the breakdown of adjuvant systemic breast cancer treatments from 1982 to 1990. The 1,760 women recorded by the cancer registry of the French Côte d'Or region (241,020 women in 1990) during 1982-1990, who were found to have both a non metastatic breast invasive carcinoma and a no perceptible residual disease after locoregional treatment completion were the subjects of this analysis. Forty percent of the patients received adjuvant treatment: 17% only had chemotherapy, 7% had chemotherapy associated with hormonal therapy and 16% only had hormonal therapy. Chemotherapy was the only adjuvant treatment for the patients under 35 years of age. Hormonal therapy was the main treatment for the patients over 74. For patients from 35 to 74 with a non-inflammatory tumour, the determination of adjuvant treatment was multifactorial. For each modality of adjuvant treatment, the logistic regression model provided an assessment of the contribution of each independant variable to the risk of being treated. This method has focused on period effect after adjustment on the tumor and patient characteristics. Adjuvant treatments were more widely used in the late 1980s than in the early 1980s (OR = 1.9; p = 0.006). On the one hand, the use of chemotherapy-hormonal therapy association remained stable and the use of chemotherapy decreased with a boundary significance (OR = 0.6; p = 0.056); on the other hand, the use of hormonal therapy dramatically increased and was 3.5 times as high for the period 1988-1990 as for the period 1982-1984 (OR = 3.5, p < 0.0001). Comprehensive study of survival trends after breast cancer should take into account the adjuvant systemic treatments and the conditions of their indications to separate their potential beneficial effects from the effects of lead time bias. Necessity of treatment indicator quality control was emphasised.

[Cancers of the corpus uteri on the Côte-d'Or 1982-1990. Incidence, clinical stage and survival]

In the French administrative "departement" of Côte-d'Or, between 1982 and 1990, the crude incidence rate and the age-adjusted world standardised incidence rate (ASR) for corpus uteri cancer were respectively 16.0 +/- 0.8 and 10.7 +/- 0.6 per 100,000 women per year. The incidence increased after 50 years of age, reaching a maximum of 66.7 per 100,000 women per year at the age of 70-74 and thereafter declined. Ninety-six percent of the patients were older than 50. The 5- and 10-year crude survival rates (all histologic types) were 66 +/- 3% and 61 +/- 4%. The 5- and 10-year relative survival rates were 76%. Histologic types were specified in 99.7% of cases, categorized as follows: 92.7% carcinomas (333 cases), 6.7% sarcomas (24 cases) and 0.3% lymphoma (one case). Carcinomas were clinically evaluated according to FIGO staging: stage I: 61.4% (205 cases); stage II: 7.7% (59 cases); stage III: 7.8% (26 cases); stage IV: 6.6% (22 cases) and unspecified stage: 6.6% (22 cases). The ASR by stage, were 6.4 +/- 0.5 (stage I); 0.8 +/- 0.2 (stage II); 1.3 +/- 0.2 (stages III and IV); 0.6 +/- 0.2 (unspecified stage). The 5-year relative survival rates related to FIGO stage were 90% (stage I); 85% (stage II); 25% (stage III) and 0% (stage IV). Elderly patients (> 75) had significantly lower survival rates. With respect to localized disease (stages I and II) the relative risk of death associated with age older than 75 was 4.9. The 5-year relative survival rate of patients with sarcoma was 37%.

Biologic and anatomic problems of lung shielding in whole-body irradiation

Lung shielding by lead blocks for reducing the dose to the lungs in whole-body irradiation results in relative protection of the leukemia cell population. The consequence is acceptable if the dose reduction is moderate (from 10 to 8 Gy) and if the shielded volume amounts to a small fraction (5%) of the body weight. The suggestion was made that certain limits should be put on the extent of shielding, so that the shielded lung fraction represents only 60% of the total lung volume.

Interstitial thermoradiotherapy: a technical and clinical study of 29 implantations performed at the Institut Gustave-Roussy

In 1981, a protocol was developed at the Institut Gustave-Roussy, combining interstitial hyperthermia and brachytherapy. Twenty-nine implantations were performed in 23 patients. All the lesions except three were located in previously irradiated areas. The protocol consisted of interstitial hyperthermia, 44 degrees C for 45 min, immediately followed by iridium-192 brachytherapy, delivering a dose of 30 Gy in the first 17 implantations, and a dose of 40 Gy in the next 12 (the dose was increased because of two local relapses in the first 17 cases). Special 'metal-plastic' tubes have been designed to heat the tumour specifically and to spare the surrounding healthy tissues. Among the 25 implantations for which a complete thermal mapping was available, a minimum temperature of 44 degrees C was reached in 16 cases, 43 degrees C in 5 cases and 42 degrees C in 4. The temperature inhomogeneity within the treated volume was less than 1 degrees C in 16 cases, and up to 4 degrees C in only one instance. Short-term clinical results (at two months) are available for 23 implantations: a 100 per cent response rate and a 83 per cent complete regression rate was observed. Follow-up is still short for most patients and long-term local control cannot be evaluated. Treatment has been generally well tolerated despite prior irradiation. Thus, technically satisfactory hyperthermia could be obtained in most cases, short-term clinical results are encouraging, and the technique merits further study.

Combined interstitial hyperthermia and brachytherapy: Institute Gustave Roussy technique and preliminary results

In 1981, a protocol was developed at the Institute Gustave-Roussy, utilizing combined interstitial hyperthermia and brachytherapy, to treat recurrent tumors in previously irradiated areas. This protocol consisted of interstitial hyperthermia, 44 degrees C for 45 minutes, followed immediately by iridium 192 curietherapy, delivering 30 Gy in 2 or 3 days to the tumor volume. Fourteen implantations have been performed in 11 patients. Complete eradication of tumor has been achieved thus far in 10 cases. Two patients were not evaluable because of rapid death resulting from diffuse metastases, and two patients demonstrated a partial response (greater than 50% tumor reduction). Treatment has been generally well tolerated despite prior high dose irradiation. There has been only one serious complication-a large area of painful necrosis following retreatment of a recurrent floor of mouth carcinoma. Special "metallic-plastic" tubes were developed to improve tissue tolerance. We were able to document that a high and homogeneous temperature could be delivered throughout the tumor volume. The technical innovations, and the techniques of implantation and temperature documentation are described below.

[Postoperative radiotherapy of rectal cancer. A retrospective study within the population of the Department of Côte-d'Or]

The registry of digestive cancer set up for French department of Cote d'Or (455,727) collects all newly diagnosed cases of rectal cancers occurring among residents. It allows to study the place and the results of postoperative radiotherapy among Dukes' B and C patients. From 1976 to 1980 postoperative radiotherapy was theorically indicated in 177 patients. Ten of the 95 Dukes' B patients (10.5 p. 100) and 26 of the 82 Dukes' C patients (31.7 p. 100) were actually irradiated postoperatively (P less than 0.001). All of the studied variables (i.e. age, sex, operative procedure, number of lymph nodes containing metastases) were not statistically different between the two groups of patients. The mean size of the tumor was slightly larger in the group treated with radiotherapy. Minor reactions after radiotherapy were frequent. There were two major complications: a small bowel obstruction and a perineal abscess with chronic fistula. The probability of local recurrence was correlated with the stage of disease and the mode of treatment. Dukes' C patients showed a 5-year local recurrence rate of 30 p. 100 after surgery alone and of 0 p. 100 after surgery and postoperative radiotherapy (P less than 0.001). The corresponding 5-year local recurrence rates for Dukes' C patients were 75 p. 100 and 26 p. 100 (P less than 0.01). The risk of local recurrence increased regularly during the 4 years following surgery. The modes of treatment did not influence the risk of developing distant metastases. Survival curves were the same for patients treated with surgery only and patients treated with combined therapy. The only difference was the 5-year survival rate of Dukes' C patients: 25 p. 100 after surgery and postoperative radiotherapy and 12 p. 100 after surgery alone but the difference was not statistically significant.