Geriatric Assessment May Improve Selection of Older Patients for Concurrent CRT
Geriatric assessmentmay improve the selection of older patients with stage III non-small cell lung cancer (NSCLC).
CHICAGO — Geriatric assessment and the Vulnerable Elders Survey (VES-13) may improve the selection of older patients with stage III non-small cell lung cancer (NSCLC) for the receipt of concurrent chemoradiotherapy, according to a poster presented at the 2016 American Society of Clinical Oncology (ASC) Annual Meeting.1
"Elderly lung cancer patients represent a heterogeneous group and their functional status cannot be predicted on the basis of chronological age," lead investigator Maite Antonio Rebollo, MD, PhD, medical oncologist at the Catalan Institute of Oncology in Barcelona, Spain, told Cancer Therapy Advisor. "Geriatric Assessment is a valuable tool able to predict severe treatment-related toxicity and overall survival in a variety of tumors."
Although concurrent chemoradiotherapy has been shown to improve survival in older patients with unresectable stage III NSCLC, its use as standard of care remains controversial. Therefore, researchers sought to determine if the Geriatric Assessment could help to identify patients who benefit from this treatment modality.
For the study, researchers prospectively analyzed data from 85 patients aged 74 years or older with unresectable stage IIIA/IIIB NSCLC who underwent Geriatric Assessment, including validated instruments to evaluate comorbidity, polypharmacy, functional status, geriatric syndromes, mood, cognition, and VES-13.
Approximately 36%, 48%, and 15% of patients were then classified according to the Geriatric Assessment as fit, medium fit, or unfit, respectively. Patients who were fit or medium fit were deemed candidates for concurrent chemoradiotherapy while unfit patients received best supportive care.
Results showed that fit and medium fit patients had a median overall survival of 20.6 and 17.5 months, respectively, which were significantly longer than that of unfit patients (10.1 months; P=.009).
"Geriatric Assessment was useful for selecting elderly patients with locally advanced NSCLC that might benefit from adapted concurrent chemoradiotherapy and seems to avoid undertreatment for those patients," Dr Antonio explained.
Researchers also found that vulnerable patients, defined as a VES-13 score ≥3, had a median overall survival of 11.6 months compared with 19.1 months among patients with a low VES-13 score (P=.008). VES score ≥3 was associated with shorter median overall survival (P=.009) and an increased risk for developing grade 3 or 4 adverse events (P=.006), including neutropenia, respiratory infection, and radiation pneumonitis.
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"VES-13 had independent prognostic value and in patients receiving concurrent chemoradiotherapy was significantly associated with higher risk of grade 3 to 4 toxicity," Dr Antonio concluded. "The value of VES-13 to predict toxicity and to assess prognosis should be further studied."
- Rebollo MA, Aceituno JL, Saldana J, et al. A prospective study assessing the value of geriatric assessment in elderly patients with stage III NSCLC for concurrent chemoradiation. J Clin Oncol. 2016; 34 (suppl; abstr 8509).