Cancer Aging Research Group (CARG) score in older adults undergoing curative intent chemotherapy: a prospective cohort study

Ostwal, Vikas; Ramaswamy, Anant; Bhargava, Prabhat; T, Hatkhambkar; Swami, Rohit; Rastogi, Sameer; Mandavkar, Sarika; Ghosh, Jaya; Bajpai, Jyoti; Gulia, Seema; Srinivas, Sujay; Rath, Sushmita; Gupta, Sudeep

doi:10.1136/bmjopen-2020-047376

Cited by 26 publications

(15 citation statements)

References 15 publications

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“…No elderly-specific trials of adjuvant chemotherapy in NSCLC have been conducted so far and a specific standardized tool for risk assessment in older patients undergoing adjuvant treatment after surgical resection is still lacking [ 21 ]. Only recently the Cancer Aging Research Group (CARG) score, which predicts grade 3–5 chemotherapy toxicity in older adults aged 65 years or older [ 22 ], has been validated in the adjuvant and neoadjuvant setting [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Major clinical benefit from adjuvant chemotherapy for stage II–III non-small cell lung cancer patients aged 75 years or older: a propensity score-matched analysis

et al. 2022

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Background Data are currently insufficient to support the use of adjuvant chemotherapy (ACT) after surgical resection for stage II or III non-small cell lung cancer (NSCLC) in patients aged ≥ 75 years. In this study we evaluated efficacy and safety profile of ACT in this population. Methods We retrospectively evaluated 140 patients ≥ 75 years who underwent curative surgical resection for stage II–III NSCLC from 2010 to 2018 with an indication to ACT according to current guidelines. A propensity score-matched analysis was performed to avoid cofounding biases. Results Thirty of 140 patients (21%) received ACT. Most patients (n = 24, 80%) received carboplatin in combination with vinorelbine, while 5 patients (17%) received cisplatin plus vinorelbine and one patient (3%) carboplatin plus gemcitabine. The occurrence of adverse events led to treatment discontinuation in 8 (27%) cases, while 19 (63%) patients completed 4 chemotherapy cycles. Common reported adverse events with ACT were anemia (n = 20, 67%), neutropenia (n = 18, 60%), thrombocytopenia (n = 9, 30%), renal impairment (n = 4, 13%) and transaminase elevation (n = 4, 13%). No toxic deaths occurred. The median follow-up was 67 months (IQR: 53–87). ACT was associated with a significant benefit in both relapse-free survival (median 36 vs. 18.5 months, p = 0.049) and overall survival (median not reached [NR] vs. 33.5 months, p = 0.023) in a propensity score-matched analysis which controlled for cofounders. Conclusion ACT confers a survival benefit after curative resection of stage II–III NSCLC in selected patients aged 75 years or older with a manageable toxicity profile.

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Section: Discussionmentioning

confidence: 99%

Major clinical benefit from adjuvant chemotherapy for stage II–III non-small cell lung cancer patients aged 75 years or older: a propensity score-matched analysis

et al. 2022

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“…These results are comparable to those of the CARG toxicity tool development and validation cohort. 26,44 Of interest, the risk of chemotherapy-related toxic effects in patients with gastrointestinal or genitourinary cancers was reduced in our study. This finding differs from the original CARG developmental cohort, in which gastrointestinal or genitourinary cancers predicted an increased risk of chemotherapy-related toxic effects.…”

Section: Jama Network Open | Oncologymentioning

confidence: 73%

“…Other studies have evaluated the utility of the CARG model outside the US. [44][45][46] Within the continent of Asia, Ostwal et al 44 have validated the utility of the CARG model in the Indian population. Suto et al 45 have similarly found that the CARG model predicted chemotherapy-related toxic effects in a small (<100 patients) retrospective study conducted in a Japanese population, whereas a prospective validation study 46 of the CARG performed in Hong Kong had negative results, which may be attributed to the inclusion of patients who received only targeted therapy and no chemotherapy in the study population.…”

Section: Discussionmentioning

confidence: 99%

Use of the Cancer and Aging Research Group Predictive Model for Chemotherapy-Related Toxic Effects in a Multiethnic, Older Adult Asian Population

Pang

Low

et al. 2022

JAMA Netw Open

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ImportanceThe Cancer and Aging Research Group (CARG) prediction model for chemotherapy-related toxic effects has been developed but not yet validated in older Asian adults. In view of differences in drug metabolism and toxic effect reporting in the Asian population, the ability of this tool to guide the cancer treatment decision-making process in older Asian adults needs to be assessed.ObjectiveTo examine the validity of the CARG predictive model in a multiethnic Asian cohort of older adults.Design, Setting, and ParticipantsIn this prognostic study, patients of various Asian ethnicities 70 years or older with a solid tumor diagnosis receiving chemotherapy at the National University Cancer Institute, Singapore, were accrued from June 1, 2017, to January 1, 2019. Their risks of chemotherapy-related toxic effects were calculated using the CARG tool. A geriatric assessment was performed, and the treating oncologist (blinded to the CARG scores) was asked to give an estimated likelihood of toxic effects (low, medium, or high). Chemotherapy-related toxic effects were recorded during each clinic visit. Validation of the prediction model was performed by calculating the area under the receiver operating characteristic curve. Multivariate analyses were performed to identify variables in other domains in the geriatric assessment predicting for severe toxic effects.Main Outcomes and MeasuresGrade 3 to 5 toxic effects and hospitalization.ResultsThe study included 200 patients (median age, 74 years [range, 70-89 years]; 110 [55.0%] male; 177 [88.5%] Chinese, 17 [8.5%] Malay, 4 [2.0%] Indian, and 2 [1.0%] other ethnicities [according to Singapore’s national system of race classification]). A total of 137 patients (68.5%) experienced grade 3 to 5 toxic effects, and 131 (65.5%) required hospitalization. The area under the receiver operating characteristic curve for the CARG chemotoxicity prediction model was 0.74 (95% CI, 0.67-0.82), retaining good discrimination in the study population.Conclusions and RelevanceThis prognostic study conducted in a multiethnic Asian cohort of older adults supports the validity of the CARG predictive model in this population, predicting which older adults are at risk of chemotherapy-related toxic effects.

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“…Previous work has demonstrated that validated measures of frailty are an important metric in assessing the benefit of a therapeutic intervention in the elderly population. The Geriatric Assessment has been successfully embedded within cooperative group clinical trials ( 34 ), and the Cancer in Aging Research Group Toxicity Score can identify subsets of older adults at higher risk of symptomatic adverse events or death ( 35 ). Clinical trial endpoints should include those outcomes that mirror the values and preferences of older adults ( 33 , 36 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

Metastatic Colorectal Cancer Outcomes by Age Among ARCAD First- and Second-Line Clinical Trials

McCleary

Harmsen

Haakenstad

et al. 2022

JNCI Cancer Spectrum

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Background We evaluated the time to progression and survival outcomes of second-line therapy for metastatic colorectal cancer among adults aged 70 years and older compared to younger adults following progression on first-line clinical trials. Methods Associations between clinical and disease characteristics, time to initial progression and rate of receipt of second-line therapy were evaluated. Time to progression and overall survival were compared between older and younger adults in first- and second-line trials by Cox regression, adjusting for age, sex, Eastern Cooperative Oncology Group Performance Status (ECOG PS), number of metastatic sites and presence of metastasis in the lung, liver or peritoneum. All statistical tests were 2-sided. Results Older adults comprised 16.4% of patients on first-line trials (870 total older adults age >70 years; 4,419 total younger adults age ≤70 years, on first-line trials). Older adults and those with ECOG PS > 0 were less likely to receive second-line therapy than younger adults. Odds of receiving second-line therapy decreased by 11% for each additional decade of life in multivariable analysis (odds ratio = 1.11, 95% confidence interval = 1.02, 1.21, P = .01. Older and younger adults enrolled in second-line trials experienced similar median time to progression and median overall survival (median time to progression = 5.1 vs. 5.2 months, respectively; median overall survival = 11.6 vs. 12.4 months, respectively). Conclusions Older adults were less likely to receive second-line therapy for metastatic colorectal cancer, though we did not observe a statistical difference in survival outcomes vs. younger adults following second-line therapy. Further study should examine factors impacting decisions to treat older adults with second-line therapy. Inclusion of geriatric assessment may provide better criteria regarding the risks and benefits of second-line therapy.

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Cancer Aging Research Group (CARG) score in older adults undergoing curative intent chemotherapy: a prospective cohort study

Cited by 26 publications

References 15 publications

Major clinical benefit from adjuvant chemotherapy for stage II–III non-small cell lung cancer patients aged 75 years or older: a propensity score-matched analysis

Major clinical benefit from adjuvant chemotherapy for stage II–III non-small cell lung cancer patients aged 75 years or older: a propensity score-matched analysis

Use of the Cancer and Aging Research Group Predictive Model for Chemotherapy-Related Toxic Effects in a Multiethnic, Older Adult Asian Population

Metastatic Colorectal Cancer Outcomes by Age Among ARCAD First- and Second-Line Clinical Trials

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