Thalidomide is an effective treatment for patients with advanced myeloma, in particular, who have no poor-risk features. The poor results achieved by the other patients emphasize the need for prospective protocols using thalidomide in combination, especially with dexamethasone. In addition, further studies are needed to determine the optimal thalidomide dose and duration.
Background: Genomic and immunologic tumor biomarker testing has dramatically changed the prognosis of patients, particularly those treated for advanced/metastatic non-squamous non-small-cell lung cancer (aNSCLC) when access to targeted agents is available. It remains unclear whether older patients have access to therapy-predictive biomarker testing techniques in the same proportion as younger patients. This study aims to compare the proportion of biomarker testing performed in non-squamous aNSCLC at diagnosis between patients aged ≥70 years old and their younger counterparts. Methods: We conducted a retrospective analysis using the Epidemio-Strategy and Medical Economics (ESME) Advanced or Metastatic Lung Cancer Data Platform, a French multicenter real-life database. All patients with non-squamous aNSCLC diagnosed between 2015 and 2018 were selected. Biomarker testing corresponded to at least one molecular alteration and/or PD-L1 testing performed within 1 month before or 3 months after the aNSCLC diagnosis. Results: In total, 2848 patients aged ≥70 years and 6900 patients aged <70 years were included. Most patients were male. The proportion of current smokers at diagnosis was higher in the <70 years group (42% vs. 17%, p < 0.0001). There was no significant difference in the proportion of biomarker testing performed between the two groups (63% vs. 65%, p = 0.15). EGFR mutations were significantly more common in the older group (22% vs. 12%, p < 0.0001) and KRAS mutations significantly more frequent in the younger group (39% vs. 31% p < 0.0001). The distribution of other driver mutations (ALK, ROS1, BRAF V600E, HER2, and MET) was similar across age. In the multivariable analysis, factors independently associated with biomarker testing were gender, smoking status, history of COPD, stage at primary diagnosis, and histological type. Conclusions: Age is not a barrier to biomarker testing in patients with aNSCLC.
Background: The SARS-CoV-2 outbreak in Paris’s region significantly affected Gustave Roussy Cancer Center. Previous analyses showed that mortality rate increases with age in the general population. Here, we report the Gustave Roussy experience on older patients (OP) with cancer during the SARS-CoV-2 outbreak. Methods: Cancer pts with suspected SARS-CoV-2 infection were admitted at Gustave Roussy starting March 12th. Screening indications have been adapted over the time. All the COVID19 pts positively tested and managed at Gustave Roussy between March 14th (1st positive case) and April 15th have been included in a REDCap database. Pts and underlying oncologic and COVID19 diseases characteristics have been collected. Cancer and COVID-19 managements and outcomes have been assessed. The primary endpoint of this analysis was the clinical deterioration, defined as the need for O2 supplementation of 6l/min, or death of any cause. Results: Among the first 137 cancer pts diagnosed with SARS-CoV-2, 36 patients were aged 70 years (26%). Most of them were female (61%) with a median age of 75.5 years old. Most frequent underlying cancers were solid tumors (92%) including GI (19%), lung (17%), GYN (14%), and head and neck (14%). Most OP (36%) were ECOG performance status 2 versus 24% in younger patients (YP). The diagnosis of SARS-CoV-2 infection was made by RT-PCR or thoracic CT scan alone in 97% and 3% of the cases, respectively, in OP and in 92% and 8% in YP. Most OP experienced symptoms prior to testing (92%) compared to YP (80%). Symptoms differed according to age with more cough with sputum production in OP (14% versus 5%), dyspnea (39% versus 31%), diarrhea (17% versus 9%), shivers (8% versus 0%), sore throat (8% versus 4%), and no anosmia or agueusia. The majority of OP were hospitalized (81%) compared to 72% of YP and treated with HCQ/AZI (15; 52%) with inclusion in the ONCOVID trial (EudraCT: 2020-01250-21) compared to 25 (35%) YP. They did not receive any IL-6 inhibitor. Only one OP was admitted in the ICU (3%). Clinical deterioration occurred in 10 OP (29%). There was no impact of age on clinical worsening (HR=1.157; 95%CI 0.55-2.42; p=0.7). However, age was associated with worse overall survival (OS) (HR=2.45 95%CI 1.02-5.92 ; p=0.0463). Results will be updated at the meeting. Conclusions: OP with cancer had a different disease presentation, same rate of clinical worsening, but worse OS in SARS-CoV-2 infection. Citation Format: Mathilde Hauchecorne, Capucine Baldini, Stéphanie Foulon, Arnaud Bayle, Bertrand Gachot, Fanny Pommeret, Helene Vincent, Tina Lamy, Celine Nagera, Christophe Willekens, Franck Griscelli, Florence Netzer, Corinne Balleyguier, Samy Ammari, Fabrice André, Florian Scotte, Benjamin Besse, Jean-Charles Soria, Fabrice Barlési, Laurence Albigès. Outcome of older cancer patients infected with Covid19 at Gustave Roussy Cancer Center [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-030.
Background: With an aging population, global cancer burden continues to rise. Increased age is an independent risk factor for not receiving aggressive therapy and is associated with shorter overall survival (OS). However, the interplay between age, cancer therapy and other factors has not been explored in depth. Here we explore the impact of and interaction between age, comorbidity and polypharmacy on OS in advanced malignancies.Methods: A retrospective cohort study was conducted including patients 18 years diagnosed with advanced breast, lung, colorectal, prostate or ovarian cancer diagnosed between 2004 and 2015 in Manitoba, Canada. Cancer stages were included if standard therapy included systemic therapy (ST). Clinical and administrative health data were used to determine demographics, oncologic characteristics, treatment, comorbidity (Charlson Comorbidity Index (CCI) and Resource Utilization Band (RUB)), polypharmacy (6 medications) and OS. Kaplan-Meier curves and multivariable Cox proportional hazards models were produced to evaluate associations with OS.Results: 15,252 patients were diagnosed with advanced or incurable solid tumors of whom 48% received ST. Patients who did not receive ST were older, had increased comorbidity, health care usage and polypharmacy. In treated patients, OS declined with increased age with median OS of 8.9, 6.1, 4.1, 3.5, 2.5, 1.9 and 1.7 years for patients aged <40, 40-49, 50-59, 60-69, 70-79, 80-89 and 90 respectively. OS differed by cancer type; breast cancer had the longest and lung cancer had the shortest OS. OS was 2.3 years for patients taking 6 medications compared to 3.9 years in those taking <6 medications. OS was the longest for individuals with low comorbidity (RUB¼ 2, CCI¼ 0). Age at diagnosis, cancer type, stage, medication count, RUB and year of diagnosis were independently associated with OS. Interactions were found between age and cancer type (p<0.001) and age with stage (p¼0.019). Conclusions:In this population-based study, age, RUB and polypharmacy each independently impacted OS in treated patients. CCI was not independently associated with OS. Polypharmacy was found to be an independent predictor of OS. Age interacted with both cancer type and stage in association with OS.
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