Optimizing the G8 Screening Tool for Older Patients With Cancer: Diagnostic Performance and Validation of a Six-Item Version

Martínez-Tapia, Claudia; Canouï‐Poitrine, Florence; Bastuji‐Garin, Sylvie; Soubeyran, Pierre; Mathoulin‐Pélissier, Simone; Tournigand, Christophe; Paillaud, Éléna; Laurent, Marie; Audureau, Étienne

doi:10.1634/theoncologist.2015-0326

Cited by 91 publications

(89 citation statements)

References 24 publications

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“…Almost, main oncogeriatric studies, with recommendations from the SIOG, are using the age of 70 years old as cut off for geriatric assessment and developing geriatric screening tools[26,27]. …”

Section: Methodsmentioning

confidence: 99%

Folfirinox in elderly patients with pancreatic or colorectal cancer-tolerance and efficacy

Guion-Dusserre¹,

Bertaut²,

Ghiringhelli³

et al. 2016

WJG

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AIMTo study the tolerance and the efficiency of FOLFIRINOX in elderly patients diagnosed with colorectal or pancreatic cancer.METHODSThis retrospective study included elderly patients aged over 70 years of age treated at Georges-Francois Leclerc Center by FOLFIRINOX for histological proved colorectal or pancreatic cancer between January 2009 and January 2015. Chemotheapy regimen consisted of oxaliplatin (85 mg/m2 in over 120 min) followed by leucovorin (400 mg/m2 in over 120 min), with the addition, after 30 min of irinotecan (180 mg/m2 in over 90 min) then 5 fluorouracil (5FU) (400 mg/m2 administred intravenous bolus), followed by 5FU (2400 mg/m2 intraveinous infusion over 46 h) repeated every 2 wk. Geriatric parameters were recorded at the beginning. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events 4.03. Tumor response was evaluated by CT scan. Treatment continued until disease progression, unacceptable toxicities or patient refusal.RESULTSFifty-two patients aged from 70 to 87 years were treated by FOLFIRINOX, 34 had colorectal cancer and 18 had pancreatic cancer. Most of them were in good general condition, 82.7% had a 0-1 performance status and 61.5% had a Charlson Comorbidity Index < 10. The most frequent severe toxicities were neutropenia (17 patients, n = 32.7%) and diarrhea (35 patients n = 67.3%); 10 of the case of neutropenia and 5 of diarrhea registered a grade 4 toxicity. Thirty-nine patients (75%) initially received an adapted dose of chemotherapy. The dosage was adjusted for 26% of patients during the course of treatment. Tumor response evaluated by RECIST criteria showed a controlled disease for 25 patients (48.1%), a stable disease for 13 and a partial response for 12 patients. Time under treatment was higher for colorectal cancer with a median time of 2.44 mo (95%CI: 1.61-3.25). Overall survival was 43.88 mo for colorectal cancer and 12.51 mo for pancreatic cancer. In univariate or multivariate analysis, none of geriatric parameters were linked to overall survival. Only the type of tumor (pancreatic/colorectal) was linked in both analysis.CONCLUSIONFor people over 70 years old, FOLFIRINOX regimen seems to induce manageable toxicities but similar, even higher, median survival rates compared to younger people.

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Section: Methodsmentioning

confidence: 99%

Folfirinox in elderly patients with pancreatic or colorectal cancer-tolerance and efficacy

Guion-Dusserre¹,

Bertaut²,

Ghiringhelli³

et al. 2016

WJG

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“…In countries or institutions where CGA is not routinely performed, its implementation in clinical trials would require additional efforts to organize and fund CGA, but one could expect that the ongoing expansion of CGA in daily practice will make it easier to implement it in future trials. Screening tools to identify patients who could benefit from a CGA may also be an interesting option to reduce the burden associated with assessing all patients comprehensively; examples include the G8 , the Cancer and Leukemia Group B (CALGB) tool , the Vulnerable Elders Survey‐13, and the Groningen Frailty Index . The infrequent use of CGA in clinical trials could also be seen as a reflection of the poor involvement of geriatricians in the design of oncology trials.…”

Section: Discussionmentioning

confidence: 99%

Changes in the Use of Comprehensive Geriatric Assessment in Clinical Trials for Older Patients with Cancer over Time

et al. 2019

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Background The objective of this study was to describe the implementation of comprehensive geriatric assessment (CGA) in clinical trials dedicated to older patients before and after the creation of the International Society of Geriatric Oncology in the early 2000s. Subjects, Materials, and Methods All phase I, II, and III trials dedicated to the treatment of cancer among older patients published between 2001 and 2004 and between 2011 and 2014 were reviewed. We considered that a CGA was performed when the authors indicated an intention to do so in the Methods section of the article. We collected each geriatric domain assessed using a validated tool even in the absence of a clear CGA, including nutritional, functional, cognitive, and psychological status, comorbidity, comedication, overmedication, social status and support, and geriatric syndromes. Results A total of 260 clinical trials dedicated to older patients were identified over the two time periods: 27 phase I, 193 phase II, and 40 phase III trials. CGA was used in 9% and 8% of phase II and III trials, respectively; it was never used in phase I trials. Performance status was reported in 67%, 79%, and 75% of phase I, II, and III trials, respectively. Functional assessment was reported in 4%, 11%, and 13% of phase I, II, and III trials, respectively. Between the two time periods, use of CGA increased from 1% to 11% (p = .0051) and assessment of functional status increased from 3% to 14% (p = .0094). Conclusion The use of CGA in trials dedicated to older patients increased significantly but remained insufficient. Implications for Practice This article identifies the areas in which research efforts should be focused in order to offer physicians well‐addressed clinical trials with results that can be extrapolated to daily practice.

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“…Renal failure and malnutrition are undoubtedly predictive factors of poor efficacy or safety; this is less the case for other factors such as polymedication. For example, a patient aged 75 years treated with polymedication, without other comorbidities or physical dysfunction, has a G8 or modified G8 score, indicating that he or she could benefit from anticancer medications . Moreover, most older adult cancer patients use concomitant medications .…”

Section: Discussionmentioning

confidence: 99%

“…For example, a patient aged 75 years treated with polymedication, without other comorbidities or physical dysfunction, has a G8 or modified G8 score, indicating that he or she could benefit from anticancer medications . Moreover, most older adult cancer patients use concomitant medications . Those that do not affect the patient's metabolism or constitute a formal contraindication to the use of anticancer medications should not lead to the systematic exclusion of older adults from these treatments .…”

Section: Discussionmentioning

confidence: 99%

Treatment Modalities and Survival in Older Adults with Metastatic Colorectal Cancer in Real Life

Gouverneur

Bezin

Jové

et al. 2019

J American Geriatrics Society

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OBJECTIVES Metastatic colorectal cancer (mCRC) is increasingly treated with targeted therapies, but little is known about real‐life mCRC treatment in older adults. The aims were to describe the real‐life first‐line treatment modalities in older adult mCRC patients, to identify factors associated with treatment modalities, and to evaluate survival with regard to treatment modalities. PATIENTS AND METHODS A cohort of mCRC patients aged 65 years and older at diagnosis was identified between 2009 and 2013 using French national healthcare insurance system claims data. Treatment modalities were: treatment with one or more anticancer medication vs best supportive care and, among treated patients, treatment with targeted therapy vs conventional chemotherapy alone. Multivariate logistic regression was used to identify factors associated with treatment by anticancer medication and by targeted therapy. Cox proportional hazards models were used to assess the independent effect of treatment modalities on overall survival while adjusting for baseline covariates identified with logistic regression. RESULTS A total of 503 patients were included with a median age of 78 years (54% were men). Of these, 299 (59%) were treated with anticancer medications. Among treated patients, 131 (44%) received targeted therapy. In multivariate analysis, age 75 years or older, renal failure, malnutrition, and five or more concomitant medications were associated with a lower likelihood of treatment with anticancer medications. Among treated patients, age 75 years or older, history of cancer, lymph node metastases, and a single metastatic site were associated with a lower likelihood of treatment with targeted therapy. Multivariate Cox proportional hazards models found that treatment with any anticancer medication tended to be associated with a lower risk of death; treatment with targeted therapy was not significantly associated. CONCLUSION A more appropriate prescription of anticancer medications in the older adult will require the definition of more explicit criteria to avoid undertreatment. The real benefit of targeted therapies vs conventional chemotherapy alone needs to be confirmed in this population. J Am Geriatr Soc 67:913–919, 2019.

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Optimizing the G8 Screening Tool for Older Patients With Cancer: Diagnostic Performance and Validation of a Six-Item Version

Cited by 91 publications

References 24 publications

Folfirinox in elderly patients with pancreatic or colorectal cancer-tolerance and efficacy

Folfirinox in elderly patients with pancreatic or colorectal cancer-tolerance and efficacy

Changes in the Use of Comprehensive Geriatric Assessment in Clinical Trials for Older Patients with Cancer over Time

Treatment Modalities and Survival in Older Adults with Metastatic Colorectal Cancer in Real Life

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