A geriatric assessment intervention led to a significant reduction in toxic effects for older patients with advanced cancer who were receiving high-risk treatment, according to research published in The Lancet.

Researchers tested this intervention in the GAP70+ trial (ClinicalTrials.gov Identifier: NCT02054741). The trial enrolled older patients with incurable solid tumors or lymphoma and at least 1 impaired geriatric assessment domain who were starting a new treatment regimen.

Patients were treated at 40 community oncology practice clusters across the United States. The practices were randomly assigned to the intervention (n=16) or usual care (n=24). For the intervention, oncologists received a tailored geriatric assessment summary and management recommendations.


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All patients underwent a geriatric assessment that evaluated 8 domains — physical performance, functional status, comorbidity, cognition, nutrition, social support, polypharmacy, and psychological status. Patients also underwent objective cognition and physical performance tests.

There were 718 eligible patients, 349 assigned to the intervention group and 369 assigned to usual care. Overall, the patients’ median age was 77.2 years, and 43% were women.

Most baseline characteristics were similar between the groups. However, the intervention group had more Black patients, more patients who had previous chemotherapy, and more patients with gastrointestinal cancers.  

In the entire cohort, the mean number of geriatric assessment domain impairments was 4.5, and there was no significant difference between the study groups.

Results: A New Standard of Care?

The incidence of grade 3-5 toxic effects was lower in the intervention group than in the usual care group — 51% and 71%, respectively (adjusted risk ratio [aRR], 0.74; 95% CI, 0.64-0.86; P =.0001).

The incidence of grade 3-5 non-hematologic toxic effects was also lower in the intervention group than in the usual care group — 32% and 52%, respectively (aRR, 0.72; 95% CI, 0.52-0.99; P =.045).

Patients in the intervention group were more likely than those in the usual care group to receive treatment at a lower dose intensity than standard at cycle 1 — 49% and 35%, respectively (aRR 1.38, 95% CI, 1.06 to 1.78; P =.015).

The reduced dose intensity did not appear to compromise survival, however. There was no significant survival difference between the study groups at 1 year (adjusted hazard ratio, 1.05; 95% CI, 0.85-1.29, P =.68).

Patients in the intervention group were more likely to have medications discontinued (mean difference, 0.14 medications; 95% CI, 0.03-0.25; P =.015) and less likely to fall over a 3-month period (aRR, 0.58; 95% CI, 0.40-0.84; P =.0035).

Based on these results, the researchers concluded that geriatric assessment-guided management should be the standard of care for older patients with advanced cancer and aging-related conditions who are starting new treatment with a high risk of toxic effects.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Mohile SG, Mohamed MR, Xu H, et al. Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study. Lancet. Published online November 3, 2021. doi:10.1016/S0140-6736(21)01789-X