Pre-emptive monitoring of scheduled chemotherapy reduced toxicity without diminishing efficacy in patients (pts) over age75 with gynecologic (GC) or lung cancer (LC) treated with paclitaxel and carboplatin (PC).

Abstract

e19530 Background: Advanced lung and gynecologic cancers are common in elderly pts but not optimally treated. Chemotherapy with PC is not recommended because of toxicity. The objective is to investigate whether a pre-emptive monitoring on the phone a few days before administration of PC can decrease toxicity. Methods: A retrospective monocentric study were conducted in Georges Pompidou European Hospital, Paris, France, in adjuvant or metastatic pts older than 75 years, treated for LC or GC with paclitaxel (175 mg/m2) and carboplatin (AUC 5) every 3 weeks. In arm A (pts treated between Sept 2003 and May 2008), pts were followed on a practice routine. In arm B (pts treated between Oct 2008 and Jul 2010), voluntary pts were included in the program “PROCHE” of Chemotherapy Optimization Program to pre-emptively confirm scheduled chemotherapy(ASCO 2010, abst 9152). Primary endpoints was toxicity (assessed with the CTC-NCI v3.0) and secondary endpoints were the number of cycles administered, reductions of doses and efficacy in metastatic pts using radiological RECIST criteria. Results: 25 pts (9 men, 16 women) were included. Median age was 78 [min 75–max 86]. Pts characteristics were well balanced in the 2 arms. Median PS was 1 [0–3] and Charlson index was 7 [3–10]. Primary and secondary endpoints are summarized in the table. For metastatic pts, response rate was higher in arm B (Partial Response: 82 vs 29% [p: 0.02]). Conclusions: In patients (pts) aged over 75 years, pre-emptive monitoring a few days before the administration of scheduled chemotherapy with PC can reduce toxicity without diminishing efficacy. Comparison of toxicity and dose administered of PC in elderly pts with and without PROCHE. Without PROCHE With PROCHE P Neutropenia 57% 9% Febrile neutropenia 14% 0% Anemia/thrombopenia 29% 18% 0.02 Neuropathy 28% 18% 0.01 Toxic death 1 0 Median number of cycles [min-max] 6 [3-9] 6 [2-9] Dose reduction per pt 42% 100% 0.002 Reduction of carboplatin per protocol 23% 29% Reduction of paclitaxel per protocol 23% 44%