Abstract
Geriatric assessment (GA) has been advocated for treatment decision in the elderly population which is at high risk of over and under-treatment. However, tumor-specific data are still missing. Our study investigated geriatric predictors of overall survival (OS) and severe chemotherapy related adverse events (CRAEs) in elderly patients treated for metastatic non-small cell lung cancer (mNSCLC) and deemed eligible for chemotherapy. We conducted a secondary analysis from ESOGIA phase III trial, which randomized patients with mNSCLC, >70 years, into 2 arms treated either according to an algorithm based on GA or according to a standard evaluation. The present analysis is based on the entire population, who all received a GA, without corrective actions. Main endpoint was 3-months OS, secondary endpoint was CRAEs grade 3 or more of the CTCAE v4.0 classification. Multivariate Cox and logistic models adjusted for time-varying chemotherapy cycle, centers and stratified by randomization arms, were performed. A total of 493 subjects were included: median age was 77 years, 74.2% were male, 79.6% were former or current smoker, 18.9% had performance status (PS) = 2, 23.9% had comorbidities with Charlson comorbidity index ≥ 2. Three months OS rate was 29.4% [CI 95% 25.2%-34.1%]. The main predictors of 3-months mortality were male gender, altered PS, loss of Instrumental Activities of Daily Living (IADL), altered mobility (Test Get Up and Go), weight loss, anemia, increased CRP/Albumine ratio and LDH. Recent weight loss interacted negatively with IADL score ≤ 6 for 3-months mortality (HR=5.71, CI95% 2.64–12.32). Comorbidities were independently related to more severe CRAEs (OR=1.94 CI 95% 1.06 – 3.56). In an elderly mNSCLC patients, deemed eligible for chemotherapy, autonomy, mobility and weight loss and combination were independent geriatric factors of early death, while comorbidities were independently associated with CRAES.
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