Chemotherapy In Elderly Patients Research Articles

Perioperative Chemotherapy in Elderly Patients with Locally Advanced Adenocarcinoma of the Stomach and the Esophagogastric Junction: A Retrospective Cohort Analysis of Toxicity and Efficacy at the National Center for Tumor Diseases, Heidelberg

Objective: Esophagogastric cancer occurs more frequently in older patients, but these are underrepresented in clinical studies establishing the current treatment standards for perioperative chemotherapy in locally advanced disease. This leads to uncertainty regarding the treatment of older patients with potentially toxic but active regimens. Methods: Using a prospectively generated database, we analyzed 63 patients aged ≥70 years undergoing perioperative chemotherapy for locally advanced esophagogastric cancer. The information included Eastern Cooperative Oncology Group (ECOG) performance status, comorbidity index, body mass index, regimen of chemotherapy, toxicity, dosage adjustments, date of surgery, application of adjuvant treatment, date of progression, and date of death. Survival times were calculated. Results: The median age was 73 years. 96.8% of the patients received an oxaliplatin-containing regimen. In 17.5% of the patients, the dosage was reduced, and treatment was previously permanently stopped in 7.9%; 80% of the patients underwent curatively intended surgery, but only 27.5% of those undergoing resection started adjuvant treatment. Major histological regression was observed in 21.6% of the patients. The median survival was 19.1 months. Significantly improved survival times were observed for patients undergoing surgery (p = 0.008) and for patients with a triplet therapy (p = 0.004). Survival was worse for patients aged ≥75 years. Conclusion: perioperative treatment is feasible and effective in elderly patients with esophagogastric cancer.

Neoadjuvant chemotherapy for elderly patients with locally advanced disease: Are we doing enough?

389 Background: The administration of neoadjuvant chemotherapy (NAC) for patients with muscle invasive urothelial carcinoma improves overall survival. Recent reports have shown that the survival benefit may be greater in patients with locally advanced disease. Our objective was to assess the utilization of NAC by stage and age using a large national tumor registry. Methods: Patients who underwent radical cystectomy for cT2-4 N0-1 M0 urothelial carcinoma diagnosed between 2003-2012 were selected from the National Cancer Data Base. We excluded those with planned radiation therapy or who received palliative care. A multivariate logistic regression analysis was constructed to identify factors that affected administration of NAC. Covariates included were clinical stage, age, race, sex, insurance status, income, Charlson index, clinical stage group, demographic location, facility location, and diagnosis year. We also used interaction terms in the regression model to determine if stage effects differed by age group. Results: A total of 16,248 patients met inclusion criteria for the study. The use of NAC increased over the study period with 6% of eligible patients receiving NAC in 2003 vs. 27.7% in 2012 (p < 0.001).Increasing utilization of NAC was noted with increasing stage (cT2N0: 15.7%; cT3N0: 19.8%; cT4N0/TanyN1: 20.9%, p < 0.001) and decreasing NAC utilization was noted with increasing age ( < 65 years: 18.5%; 65-74 years: 18.5%; ≥ 75 years: 9.0%, p < 0.001). Following adjustment, increasing clinical stage was associated with an increase in the administration of NAC, (cT3N0 OR 1.46 [CI 1.24-1.71]; T4/TanyN1 OR 1.88 [CI 1.62-2.18]) compared to cT2 disease. In comparison, increasing age (age 65-74 years OR 0.78 (CI 0.68-0.88]; age ≥ 75 years OR 0.37 [CI 0.33-0.43]) was associated with decreased utilization of NAC compared to patients < 65 years. On interaction analysis the effect of higher stage on the likelihood of receiving NAC was attenuated in older patients ( ≥ 75 years). Conclusions: The administration NAC has increased over the last 10 years and is more likely to be given to patients with locally advanced disease or early nodal stage. However, this trend is substantially attenuated in older patients ( ≥ 75 years).

Efficacy and Safety of FOLFIRI Regimen in Elderly Versus Nonelderly Patients with Metastatic Colorectal or Gastric Cancer.

Irinotecan-based chemotherapy is a standard backbone of therapy in patients with metastatic colorectal cancer (CRC) or gastric cancer (GC). However, there is still a paucity of information concerning the efficacy and safety of irinotecan-based regimens in elderly patients. Using the patient cohort (n = 1,545) from the UGT1A1 genotype study, we compared the efficacy and safety between elderly and nonelderly patients with metastatic CRC (n = 934) or GC (n = 611) who received first- or second-line FOLFIRI (irinotecan, leucovorin, and 5-fluorouracil) chemotherapy. Despite lower relative dose intensity in elderly patients, progression-free survival and overall survival were similar between elderly (age ≥70 years) and nonelderly (<70 years) patients in the CRC cohort (hazard ratio [HR], 1.117; 95% confidence interval [CI], 0.927-1.345; p = .244, and HR, 0.989; 95% CI, 0.774-1.264; p = .931, respectively) and the GC cohort (HR, 1.093; 95% CI, 0.854-1.400; p = .479, and HR, 1.188; 95% CI, 0.891-1.585; p = .241, respectively). In both cohorts, febrile neutropenia (22.1% vs. 14.6% in CRC cohort and 35.2% vs. 22.5% in GC cohort) and asthenia (grade 3: 8.4% vs. 1.7% in CRC cohort and 5.5% vs. 2.9% in GC cohort) were more frequent in elderly patients. In the CRC cohort, mucositis and anorexia were more frequent in elderly patients. In the GC cohort, nausea and vomiting were less frequent in elderly patients. The efficacy of the FOLFIRI regimen was similar between elderly and nonelderly patients in both the CRC and the GC cohorts. However, special attention should be paid to elderly patients because of increased risk for febrile neutropenia and asthenia. The Oncologist 2017;22:293-303 IMPLICATIONS FOR PRACTICE: The efficacy of FOLFIRI (irinotecan, leucovorin, and 5-fluorouracil) chemotherapy in elderly patients with metastatic colorectal cancer or gastric cancer was similar to that in nonelderly patients. However, special attention should be paid to elderly patients because of the increased risk for febrile neutropenia and asthenia. These data suggest that the FOLFIRI regimen could be considered as a standard backbone of therapy in elderly patients with metastatic colorectal cancer or gastric cancer and that the clinical decision between doublet and singlet chemotherapy may not be based solely on age. However, the data require further assessment of frailty and performance status.

Abstract P5-16-22: Survival after adjuvant and neoadjuvant chemotherapy in elderly patients with triple negative breast cancer: A Cleveland Clinic experience

Abstract Background: Triple negative breast cancer (TNBC) comprises of approximately 15% of the total breast cancers. There is limited data on treatment outcome of these patients in elderly population. We report our experience with elderly patients with TNBC treated at our tertiary care centers. Objectives and rationale: 1. Percentage of TNBC patients who received neoadjuvant chemotherapy (NACT) vs. Adjuvant chemotherapy (ACT). 2. Chemotherapeutic agents used for NACT and ACT. 3. Progression free survival (PFS) and overall survival (OS) after neoadjuvant CT and adjuvant CT. 4. Outcomes between elderly patients 65-74 years vs. 75 years and above. Methods: With IRB approval, the Cleveland Clinic's database was used to identify TNBC patients treated between 2000 to 2013. OFS from the diagnosis of TNBC was the primary end point. Cox proportional hazard models with stepwise variable selections were used for data analysis. Results: A total of 223 patients, divided in to two groups, were prospectively followed. The age group from 65-74 years consisted of “Group A” (N=140, median 69) and 75 or older formed “Group B” (N= 83, median 80, maximum 92). Eighty eight percent had ductal carcinoma. Clinically majority had stage I (50%) and stage II (33%) disease; 17% had stage III disease and most tumors were poorly differentiated (74%, grade 3). Slightly more than half the patients had lumpectomies (55%); and in only 13% of cases (25/190) were margins positive. Patients who received neoadjuvant (NACT), aduvant chemotherapy (ACT) and radiation therapy (RT) were 65%, 53% and 38% respectively. For NACT primarily doxorubicin, cyclophosphamide and paclitaxel were used whereas for ACT it was docetaxel with cyclophosphamide. Group B had somewhat poorer performance status than younger patients (p=.05), received chemotherapy especially neoadjuvant therapy much less frequently (p&amp;lt;.0001). OS and PFS were significantly lower in Group B (p=0.001 and 0.007 respectively). This holds true even if one adjusts for performance status and use of chemotherapy (p=0.04 and 0.03 respectively). Conclusion: Among elderly patients with triple negative breast cancer, those above 75 years and older have poorer outcomes compared to those with age 65-74 years. However, this is a retrospective study and has limitations; prospective randomized studies are needed to confirm these findings. Citation Format: Mohapatra S, Seepana J, Haddad A, Spiro T, Daw H. Survival after adjuvant and neoadjuvant chemotherapy in elderly patients with triple negative breast cancer: A Cleveland Clinic experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-22.

Abstract P5-14-08: Adjuvant and neoadjuvant chemotherapy for elderly patients (≥70 years) with early high-risk breast cancer: A retrospective analysis of 116 patients

Abstract Background: adjuvant or neoadjuvant chemotherapy in elderly patients (pts) is currently considered as a toxic treatment and reserved for fit women and high-risk breast cancer; few guidelines are available in this age group. The aim of this study was to evaluate the tolerability of chemotherapy in this patient population. Patients and Methods: We performed a retrospective analysis of the use of adjuvant and neo adjuvant chemotherapy in our Cancer Center in two groups of patients (≥70y-75y and &amp;gt;75 y) with early high-risk breast cancer. Between 2009 and 2014, 116 consecutive breast cancer patients (90pts:70-75y and 26pts:75&amp;gt;y: range70-84) received adjuvant or neoadjuvant chemotherapy; all patients had optimal surgery. The chemotherapy regimens were 3 FEC100 (epirubicine 100mg/m2 + 5-fluorouracil and cyclophosphamide 500mg/m2) + 3 docetaxel100mg/m2 or 4 TC( docetaxel 75mg/m2 + cyclophosphamide 600mg/m2). In case of HER2 positive breast cancer (IHC3+ or Sish+), the patients received trastuzumab for one year. The treatment is considered non optimal when there was a decrease in the number of courses or a dose reduction. However Docetaxel75mg/m2 after 3 FEC100 was considered acceptable as well as weekly administration. A yearly follow-up was performed after the end of the chemotherapy. The association between clinical data and age group (70-75) or (&amp;gt;75) was analyzed with Khi-2 test or Fisher test. Results Pts &amp;gt; 75y had more ≥ 3 co-morbidities: (38.5% vs 18.9% (p= 0.04), had more frequently triple negative breast (TN) breast cancer (53.8% vs 20% (p=0.001), inflammatory breast cancer (19.2% vs 3.3%) (p=0.014). Pts&amp;gt;75y had less frequently RH+ breast cancer (23.1% vs 61.1% (p=0.001); there was no significant differences for N+ between the two groups. The &amp;gt;75y pts received more frequently growth factors: 57.7% vs 35.6% (p=0.043); they had more often comprehensive geriatric assessment: 42.3% vs 11.1% (p&amp;lt;0.001) and were more often hospitalized (38.5% vs12.2% (p=0.002). There was no differences between the two age groups for Her2 status, SBR histoprognostic grading, grade ≥3 toxicity, 1year and persistent toxicity. One patient died in the group 70y-75y because of sepsis. There was no differences between the age groups in the rate of decrease of chemotherapy dosing. There was a statistical association between co-morbidities and grade ≥3 toxicity (p=0.004), grade≥3 toxicity and hospitalization rate (p&amp;lt;0.001), grade ≥3 toxicity and chemotherapy dosing (p&amp;lt;0.001). Conversely no association was found between chemotherapy dosing and 1 year health status. One year Trastuzumab was well tolerated in both groups. Conclusions: Adjuvant or neo adjuvant chemotherapy for elderly high-risk breast cancer patients is feasible. The &amp;gt;75 years old patients, those with ≥3 co morbidities are especially frail, at risk of toxicity, hospitalization, inadequate chemotherapy. These results questioned about the best tools for survey and the value of geriatric intervention along the treatment. Citation Format: Servent V, Tresch E, Vuagnat P, Bonneterre J. Adjuvant and neoadjuvant chemotherapy for elderly patients (≥70 years) with early high-risk breast cancer: A retrospective analysis of 116 patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-14-08.

Chemotherapy and survival benefit in elderly patients with advanced gastric cancer.

45 Background:There is little evidence if chemotherapy (CT) offer survival benefit for elderly patients (EP) with advanced gastric cancer (AGC). Methods: This was a single-centre retrospective study. A total of 118 patients with AGC were hospitalized at our hospital from April 2012 to June 2016. Of them, EP older than 75 years with AGC were eligible for inclusion in the study. Basically, the treatment strategy, chemotherapy (CT) or best supportive care (BSC) were comprehensively decided according to their background. We evaluate the risk factors for survival using the Cox proportional hazard model and explored the optimal indication for CT for EP. Results: Of 118 patients with AGC, 47 patients were enrolled as EP [63% men; mean age, 81 years]. Of EP, 26 patients (55%) received CT and 21 patients received BSC. As first-line CT, 13 patients received S1 monotherapy, the others treated with combination agents. The median overall survival time (MST) was 138 days. There was no significant difference between CT and BSC group (172 vs. 118 days, p = 0. 1087). Univariate analysis revealed the following 5 factors for poor prognosis were significant (defined as p-value &lt; 0.1): Performance status (PS) 3a 2 (HR3.7, 95% CI: 1.5-8.5), C-reactive protein levels 3a 1mg/dL (HR4.0, 95% CI: 1.8-9.4), albumin level &lt; 3g/dL (HR2.1, 95% CI: 1.1-4.3), neutrophil/lymphocyte ratio (NLR) 3a 4 (HR3.7, 95% CI: 1.7-8.5), and diffuse type (HR1.8, 95% CI: 0.9-3.8). As each poor risk factor of 5 and age factor 3a 80 years represents point 1, we calculated total points (0-6) for each patient. Median total points of CT and BSC were 2 and 4, respectively (p = 0.0196). Therefore, we set cut-off point of 3. Then, EP with a total point of 3 and more were classified as high risk group (HR: N = 25) and the others were as low risk group (LR: N = 22). There was significantly longer MST in LR than HR (all EP; 457 vs 105 days, HR: 0.23, p = 0.0002 and EP with CT; 232 vs 113 days, HR:0.26, p = 0.0085). Conclusions: Our findings using the scoring system including 6 factors suggest that EP with a total point 3 and more, were poor prognosis and may not receive benefit from CT for AGC. When judging indication for CT in EP with AGC, this scoring system may be useful, and in case of LR (total point 0-2) may be considered an indication for CT.

Optimal indications for chemotherapy in elderly patients with unresectable pancreatic cancer.

450 Background: Pancreatic cancer is seen predominantly in elderly patients. Since many patients with pancreatic cancer have locally advanced unresectable tumors or distant metastases at diagnosis, they require chemotherapy. However, it is difficult to appropriately select elderly patients who are likely to benefit from chemotherapy. This study aimed to identify prognostic factors for elderly patients with unresectable pancreatic cancer treated with chemotherapy. Methods: We retrospectively analyzed the data of 191 patients with pancreatic cancer, aged ≥ 70 years, who had been diagnosed at our hospital between January 2006 and August 2016. Their overall survival (OS) was calculated using Kaplan-Meyer analysis. Prognostic factors were evaluated using Cox regression analysis. Results: Of the 191 patients, 52 patients with unresectable pancreatic cancer were treated with chemotherapy. Their median age was 76.5 years (range, 70–85 years). Twenty-two patients (42%) were men, and 44 (85%) had metastatic disease. Forty-one (79%) and 11 (21%) patients had ECOG performance status (PS) 0–1 and 2–3, respectively. Thirty-eight (73%), 10 (19%), and 4 (8%) patients received gemcitabine, gemcitabine-based combination regimens, and S-1, respectively, as first-line chemotherapy. The median OS was 219 days (range, 7–920 days). On univariate analysis, ECOG PS ≥ 2 (hazard ratio [HR], 4.37; P = 0.0005), carcinoembryonic antigen ≥ 10 ng/mL (HR, 2.32; P = 0.0162), serum AST ≥ 30 U/L (HR, 2.02; P = 0.0263), serum albumin &lt; 3.0 g/dL (HR, 2.38; P = 0.0247), serum C-reactive protein ≥ 0.5 mg/dL (HR, 2.21; P = 0.0140), neutrophil-to-lymphocyte ratio ≥ 5.0 (HR, 3.25; P = 0.0066), and presence of ascites on computed tomography (CT) scans (HR, 3.02; P = 0.0016) were significantly associated with shorter survival times. On multivariate analysis, ECOG PS ≥ 2 (HR, 5.49; 95% confidence interval [CI], 2.18–13.32; P = 0.0005) and presence of ascites on CT scans (HR, 2.53; 95% CI, 1.20–5.24; P = 0.0148) were associated with poor OS. Conclusions: Elderly patients with unresectable pancreatic cancer who have a good performance status and do not show ascites on CT scans are likely to benefit from chemotherapy.

Indications for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in elderly patients with peritoneal malignancy.

A combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) is effective for some peritoneal malignancies. However, the indications for elderly patients remain unclear, with substantial postoperative morbidity and mortality being problematic. Clinical data were analyzed in 42 patients undergoing CRS+HIPEC for peritoneal malignancy. The primary tumor was located in the appendix in 32 cases and elsewhere in 10 cases. Operative results and survival data were compared between patients aged ≥70 and <70years. Fourteen patients were older than 70years. Elderly patients had a higher peritoneal cancer index (32.0 vs. 21.5), higher CA19-9 level (189.0 vs. 28.1), and higher frequency of grade 4-5 complications (5/9 vs. 2/26) than the younger patients. Grade 4-5 respiratory failure occurred in three elderly patients. There was a significant difference of postoperative survival between the elderly patients and younger patients, with 5-year survival rates being 41.3 and 74.2%, respectively (p=0.0166). The poor prognosis of elderly patients was related to the higher frequency of grade 4-5 complications. Elderly patients were referred for treatment with more advanced disease than younger patients. An age ≥70years was associated with more frequent grade 4-5 complications and worse survival. Performing CRS+HIPEC in elderly patients should be considered carefully due to the risk of severe complications, especially respiratory failure.

A Risk-benefit Assessment Approach to Selection of Adjuvant Chemotherapy in Elderly Patients with Early Breast Cancer: A Mini Review.

Decision-making regarding the use and selection of adjuvant chemotherapy for breast cancer in elderly patients is challenging due to the presence of age-related comorbidities, frailty, and competing causes of mortality. One area, relatively neglected in most guidelines, is the effect of competing causes of mortality on presumed benefit of adjuvant chemotherapy for breast cancer in these patients. This article utilizes a clinical case to illustrate the principles of risk-benefit assessment of adjuvant chemotherapy in elderly patients. We suggest an approach that incorporates validated tools for estimating survival benefits of adjuvant chemotherapy, geriatric assessment, predicting toxicity, and estimating remaining life expectancy without cancer. Integration of all these variables provides a better picture of the possible benefits and harms of adjuvant chemotherapy in this population compared to conventional approaches that incorporate tumor-related variables and nonstandard measures of geriatric assessment.

Effect of Second-Line Chemotherapy in Elderly Patients with Non-Small Cell Lung Cancer

Background: The effect of second-line chemotherapy in patients with non-small cell lung cancer (NSCLC) who received first-line chemotherapy at the age of ≥ 75 years is unclear. Methods: Sixty-five elderly patients with NSCLC who received first-line chemotherapy at the age of ≥ 75 years and treated with second-line chemotherapy at Shizuoka Cancer Center between January 2005 and December 2014 were retrospectively reviewed. Results: The overall response rate of the second-line chemotherapy was 9.2% [95% confidence interval (CI) 4-19]. The median progression-free survival at the second-line chemotherapy was 2.2 months. The median overall survival at the second-line chemotherapy was 7.5 months. Multivariate analysis of prognostic factors showed that an Eastern Cooperative Oncology Group performance-status score (PS 0–1/PS 2; HR, 0.396; 95% CI, 0.192–0.899; p=0.03) and histology (squamous/non-squamous; HR, 0.465; 95% CI, 0.228–0.884; p=0.02) were significantly independent prognostic factors. On the other hand, the number of treatment-related deaths was 2 (3.1%) due to pneumonitis. Moreover, the proportion of patients who received third-line chemotherapy was only 35.9%. Conclusion: Our study suggests that elderly patients have difficulty moving on to the next line of chemotherapy; however, selected elderly patients well tolerated the adverse effects of second-line chemotherapy, and second-line chemotherapy might be effective for elderly patients with NSCLC who received first-line chemotherapy at the age of ≥ 75 years. Therefore, prospective study should be planned in order to demonstrate the efficacy of second-line chemotherapy for elderly patients with NSCLC.

高齢頭頸部癌患者に対する癌薬物療法

高齢頭頸部癌患者に対する癌薬物療法

Treatment outcomes of dose-attenuated CHOP chemotherapy in elderly patients with peripheral T cell lymphoma.

BackgroundWhile cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) is the most commonly used chemotherapeutic regimen for patients with peripheral T-cell lymphomas (PTCLs), elderly patients are more vulnerable to associated toxicities. We evaluated the efficacy and safety of dose-attenuated CHOP in elderly patients with PTCL.MethodsPatients with PTCL aged >70 years or 65–70-years with comorbidities were treated with dose-attenuated CHOP (cyclophosphamide: 562.5 mg/m2, doxorubicin: 37.5 mg/m2, vincristine: 1.4 mg/m2, and prednisolone: 100 mg for five days; 25% reduced dose of cyclophosphamide and doxorubicin vs. full-dose CHOP) as first-line therapy were included.ResultsForty-four patients (median age, 74 yr) were analyzed. The majority (N=42, 95.5%) had advanced stage disease and 36 (81.8%) were classified as high/high-intermediate risk by the international prognostic index. The overall response rate was 61.4%, and 21 patients achieved complete response (47.7%). With median follow-up period of 28.8 months, the estimated two-year progression-free and overall survival rates were 36.7% and 46.6%, respectively. Grade 3/4 neutropenia and thrombocytopenia occurred in 26.9% and 7.4% of 204 total cycles, which affected 76.7% and 25.6% of the patients, respectively. Nineteen patients (44.2%) experienced febrile neutropenia, and six died due to treatment-related toxicities. High lactate dehydrogenase levels and an involvement of >1 extranodal sites were prognostic indicators of poor survival.ConclusionDose-attenuated CHOP does not compromise treatment efficacy but retains significant toxicity. Our results suggest that some patients can be effectively treated with dose-attenuated CHOP, however a novel therapy for elderly patients with PTCL is required.

Efficacy and toxicity of adjuvant chemotherapy in elderly patients with colorectal cancer: the ACCORE study

BackgroundElderly patients with primary colorectal cancer (CRC) are less frequently treated with adjuvant chemotherapy than younger patients due to concerns regarding toxicity and efficiency. We investigated how age, performance status (PS) and comorbidity influence treatment outcomes.Patients and methodsA retrospective single-centre study of 529 patients with stages II–III CRC treated with adjuvant chemotherapy (5-fluorouracil/capecitabine+/÷oxaliplatin) from 2001 to 2011 at Herlev Hospital, Denmark. Baseline characteristics, chemotherapy and outcome were analysed with respect to age after adjusting for PS and comorbidity.ResultsElderly patients (>70 years) had significantly more comorbidity (p<0.001) and poorer PS (p=0.001) than younger patients. Elderly were more frequently treated with single-agent therapy (p=0.001) and at lower initial dose (p<0.001). There was no age-dependent difference in 3-year disease-free survival (DFS; HR 1.09, 95% CI 0.80 to 1.47, p=0.59), in grade 3–5 toxicity (29% vs 28%, p=0.86) or in 10-year CRC mortality (28%, HR 1.07, p=0.71). In elderly patients, a reduction in chemotherapy dose intensity compared with full dose had no impact on DFS or CRC mortality. Elderly patients receiving <50% of planned cycles had shorter DFS (HR=1.78, p=0.020) and higher CRC mortality (HR=2.17, p=0.027) than elderly receiving all cycles. Poor PS in younger and elderly patients was related to shorter DFS (HR=1.95, p=0.002; HR=1.6, p=0.035, respectively) and overall survival (OS; HR=2.28, p<0.001; HR=2.03, p=0.002). Comorbidity in younger patients was significantly related to shorter DFS (HR 2.72, p<0.001), OS (HR 3.16, p<0.001) and higher CRC mortality (HR 2.70, p=0.001).ConclusionsChoice of regimen, primary dose reduction and given dose intensity in patients treated with adjuvant chemotherapy for CRC were highly dependent on age. However, age had no impact on DFS and CRC mortality. Comorbidity in younger patients and PS in all patients were associated with shorter DFS and higher CRC mortality.

Concurrent chemoradiotherapy followed by docetaxel and cisplatin consolidation chemotherapy in elderly patients with esophageal carcinoma

To investigate the clinical efficacy of consolidation chemotherapy with docetaxel and cisplatin (DP) in elderly patients of esophageal cancer. Methods: Seventy-nine elderly patients of esophageal cancer were randomly divided into the treatment group (38 patients) and the control group (41 patients). Intensity modulated radiation therapy (IMRT) was applied in both groups and prescribed dose was set to 56 to 59.4 Gy in 28 to 33 fractions. The concurrent chemotherapy regime for both groups was as follow: docetaxel 25 mg/m2 plus cisplatin 25 mg/m2, per week. After concurrent chemoradiotherapy, consolidated chemotherapy was applied to the treatment group with docetaxel 60 mg/m2 and cisplatin 75 mg/m2 for 3 weeks in one cycle. There was no subsequent treatment for the control group. Results: The clinical efficacy was assessed in 76 patients. For the treatment group, 31 patients (response rate, 89.2%) obtained effective response, including 10 cases with complete response (CR) and 21 cases with partial response (PR), both of which were significantly more than that in the control group (response rate, 61.5%), with 9 cases of CR and 15 cases of PR. The median progression-free survival was 19.7 months in the treatment group, clearly longer than that in the control group (10.8 months, P=0.04). The overall survival for 1-year, 2-year and 3-year were 78.5%, 57.9% and 37.8% in the treatment group versus 61.2%, 42.3% and 22.7% in the control group (P>0.05), respectively. Grade 1 and 2 adverse effects were commonly observed in both groups, such as hematologic toxicity and radiation-induced esophagitis, but there was no significant difference between the two groups. Conclusion: For elderly patients with esophageal carcinoma, the overall response rate can be significantly improved by concurrent chemoradiotherapy with subsequently consolidated chemotherapy based on docetaxel and cisplatin..

Comparison of Reduced-Intensity Idarubicin and Daunorubicin Plus Cytarabine as Induction Chemotherapy for Elderly Patients with Newly Diagnosed Acute Myeloid Leukemia

The therapy in elderly patients with acute myeloid leukemia (AML) is a big challenge because of poor risk factors and inferior tolerance to intensive chemotherapy. This study aims to compare the efficacy between reduced-intensity idarubicin plus cytarabine and daunorubicin plus cytarabine (IA regimen and DA regimen, respectively) in elderly patients with newly diagnosed AML. We retrospectively investigated 74 patients with newly diagnosed non-M3 AML aged >60years, where 33 patients received IA regimen, 30 patients received DA regimen, while 11 patients received supportive treatment. We observed the complete remission (CR) rates, overall survival (OS) and side effects in different arms. The CR rate in IA arm (70.4%, 19/27) was significantly higher than that in DA arm (40%, 10/25) in de novo AML (p=0.028), and further significantly higher when white blood cell (WBC) count >10×109/L (p=0.042) and ECOG (Eastern Cooperative Oncology Group) score <2 (p=0.021). The overall survival of the entire population was poor with a median survival of 10months, 1- and 2-year survival rates were 40.5% (30/74) and 9.5% (7/74). The median survival of the patients with chemotherapy was 12months, which was significantly longer than patients treated supportively (4months) (p<0.001). There were no differences of median survival and duration of CR between two arms. Early mortality decreased in the past 5years in both groups. Meanwhile, low-dose idarubicin was well tolerated in elderly patients. Reduced-intensity chemotherapy offered an improvement in survival, and the reduced-intensity IA regimen could improve CR rate in elderly patients with de novo AML.

650P - Efficacy and tolerability of first-line chemotherapy in elderly patients (age ≥70 years) with metastatic gastric cancer: a multicenter study of the Anatolian Society of Medical Oncology (ASMO)

650P - Efficacy and tolerability of first-line chemotherapy in elderly patients (age ≥70 years) with metastatic gastric cancer: a multicenter study of the Anatolian Society of Medical Oncology (ASMO)

551P - Bevacizumab combined with 1st line chemotherapy in elderly patients (≥75 years-old) with metastatic colorectal cancer - Interim results according to the chemotherapy regimen (CASSIOPEE)

Standard treatments of metastatic colorectal cancer (mCRC) have been studied in a limited number of elderly patients (pts) despite the increasing incidence of cancer due to population aging. This ongoing prospective, multicenter non-interventional study, evaluates 1st line bevacizumab (Bv) combined with standard chemotherapy (CT) in elderly mCRC pts over 24 months (mo) in French daily practice. The primary objective was to describe progression-free survival. Secondary objectives include pts characteristics, overall survival, Bv modalities of use, safety and autonomy criteria. Interim results at 12 mo of follow-up (FU) according to chemotherapy regimens are presented. On a total of 351 patients (efficacy population), among 403 pts consecutively included between 2012 and 2014, initiating Bv + CT, 181 pts (52%) are men, mean age is 81 years ±4, and 282 pts (80%) had primary tumor in the colon. At diagnosis, 192 pts (56%) had synchronous metastatic disease and 74 pts (22%) had metachronous metastatic disease. Main metastatic sites were liver (229 pts, 65%), including liver only (134 pts, 38%). Main CT combined with Bv was FOLFOX for 127 pts (36%), FOLFIRI (102 pts, 29%), 5 FU-LV (75 pts, 21%), Xeloda monotherapy (32 pts, 9%) and other CT (15 pts, 4%). Mean treatment duration for FOLFOX was 4.71 mo ±2.99, FOLFIRI 4.72 mo ±3.38, 5FU-LV 4.40 mo ±3.49, and; XELODA 3.88 mo ±3.23. At 12 mo FU, median PFS was 10.8 mo [95% CI:9.0; 12.5] with oxaliplatin-based CT (131 pts; 37.3%), 9.8 mo [8.2; 11.1] with irinotecan-based CT (103 pts; 29.3%) and 7.7 mo [5.8; 9.3] with 5FU-based CT (107 pts; 30.5%). Median Overall survival was 20.7 mo [18.5; -] with oxaliplatin-based CT, 19.8 mo [15.1;-] with irinotecan-based CT, and 13.7 mo [11.1; 17.5] with 5FU-based CT. AEs grade ≥ 3 occurred in 34% pts (safety population, n= 382) including 28% Bv related AEs, and 3% pts died of an AE. CASSIOPEE provides an overview of 1st line CTs pattern combined with Bv in elderly patients with mCRC in daily French practice. Polychemotherapy was administered in nearly 70% pts. PFS and safety results are comparable to published randomized studies.

Concurrent Chemotherapy in Elderly Patients With Head and Neck Cancer

Concurrent Chemotherapy in Elderly Patients With Head and Neck Cancer

L13 - Methotrexate chemotherapy in elderly patients with locally advanced head and neck cancer: preliminary results

L13 - Methotrexate chemotherapy in elderly patients with locally advanced head and neck cancer: preliminary results

Dasatinib and low-intensity chemotherapy in elderly patients with Philadelphia chromosome–positive ALL

AbstractPrognosis of Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL) in the elderly has improved during the imatinib era. We investigated dasatinib, another potent tyrosine kinase inhibitor, in combination with low-intensity chemotherapy. Patients older than age 55 years were included in the European Working Group on Adult ALL (EWALL) study number 01 for Ph+ ALL (EWALL-PH-01 international study) and were treated with dasatinib 140 mg/day (100 mg/day over 70 years) with intrathecal chemotherapy, vincristine, and dexamethasone during induction. Patients in complete remission continued consolidation with dasatinib, sequentially with cytarabine, asparaginase, and methotrexate for 6 months. Maintenance therapy was dasatinib and vincristine/dexamethasone reinductions for 18 months followed by dasatinib until relapse or death. Seventy-one patients with a median age of 69 years were enrolled; 77% had a high comorbidity score. Complete remission rate was 96% and 65% of patients achieved a 3-log reduction in BCR-ABL1 transcript levels during consolidation. Only 7 patients underwent allogeneic hematopoietic stem cell transplantation. At 5 years, overall survival was 36% and up to 45% taking into account deaths unrelated to disease or treatment as competitors. Thirty-six patients relapsed, 24 were tested for mutation by Sanger sequencing, and 75% were T315I-positive. BCR-ABL1T315I was tested by allele-specific oligonucleotide reverse transcription–quantitative polymerase chain reaction in 43 patients and detection was associated with short-term relapses. Ten patients (23%) were positive before any therapy and 8 relapsed, all with this mutation. In conclusion, dasatinib combined with low-intensity chemotherapy was well-tolerated and gave long-term survival in 36% of elderly patients with Ph+ ALL. Monitoring of BCR-ABL1T315I from diagnosis identified patients with at high risk of early relapse and may help to personalize therapy.