Predicting Chemotherapy Toxicity and Death in Older Adults with Colon Cancer: Results of MOST Study

Abstract

Purpose Older patients with colon cancer (CC) are vulnerable to chemotherapy toxicity and death. Establishing simple scores specific for patients with CC to predict severe chemotoxicity or early death is needed to select the best treatment strategy. Subjects, Materials, and Methods This prospective multicenter study included patients aged ≥70 years with CC receiving adjuvant or first‐line metastatic chemotherapy. Frailty markers (nutrition, physical activity, energy, mobility, strength), comprehensive geriatric assessment (functional status, comorbidities, falls, nutrition, cognition, and depression), and usual laboratory parameters were collected. Logistic or Cox regression was used to examine at 500 days the association between frailty markers, comprehensive geriatric assessment, laboratory parameters, and grade 3–4 toxicity or death. Results A total of 97 patients (median age, 79.0 years) received adjuvant (37.1%) or metastatic (62.9%) chemotherapy. During the first 500 days, grade 3–4 toxicity occurred in 49.5%, and 30% died. The predictive model for grade 3–4 toxicity combined (polychemotherapy × 3) + (hypoalbuminemia <32 g/L × 2) + (abnormal grip strength × 1.5) + C‐reactive protein >11 mg/L + Eastern Cooperative Oncology Group performance status (ECOG‐PS), cutoff score >3. The predictive model for death combined (metastasis × 5) + (age × 2) + alkaline phosphatase >100 IU/mL + sex (female) + abnormal grip strength + ECOG‐PS, cutoff score >6. For chemotoxicity prediction, sensitivity was 81.6% and specificity 71.4%. For death prediction, sensitivity was 89.7% and specificity was 83.6%. Conclusion These simple and efficient “ColonPrediscores” will help to better identify older patients with CC with increased risk of chemotherapy‐related toxicity and/or death. Implications for Practice The two scores assessed in this study, called “ColonPrediscores”, offer a major advantage in that they do not need a previous complete geriatric assessment, which makes them an easy‐to‐use tool in oncologic settings.

Nutritional status according to the mini nutritional assessment (MNA)® as potential prognostic factor for health and treatment outcomes in patients with cancer – a systematic review

“…Almost half of the studies [16, 34-36, 40-43, 45, 48-50, 55, 60, 62, 63, 66-68, 75, 78, 80, 82, 84, 86] reported on patients with various types of cancer. Thirty studies [33, 37-39, 44, 46, 47, 51-54, 56-59, 61, 65, 69-74, 76, 77, 79, 81, 83, 85, 87] focused on a specific type, with lung [52-54, 56, 81, 87] and colorectal cancer [37,39,44,46,51,65,69,76,77] as the most common types. Fifteen studies [33, 39, 44, 52-58, 60, 76, 81, 84, 87] [16, 38, 39, 43, 45, 50, 58, 59, 61, 63, 67, 68, 73-77, 81, 85, 86] the MNA-SF, and in 5 studies [33][34][35][36][37] a stepwise approach that considered both forms was used.…”

“…Nine studies investigated the association between baseline MNA and treatment toxicity [46,48,58,69,73,76,80,81,84] (Table 2, Additional file table 3d). In only 1 of these studies [48], a significant higher risk for nonhematologic toxicity was shown for patients with (risk of) malnutrition compared to well-nourished patients, while for other toxicity outcomes (hematologic, acute radiotherapy or significant toxicity) MNA-result was not predictive [46,73,80] or not investigated in adjusted analyses [69,76,81,84].…”

High Serum Vitamin B12 Levels Associated with C-Reactive Protein in Older Patients with Cancer

“…In the chemotoxicity scores Cancer and Aging Research Group (CARG) and CRASH, age was included only in the CARG score [33,35]. In a recent predicting death score in older adults with colon cancer, age >82 years was selected as prognostic factor [36]. But older age alone should not be decisive for oncological treatment decision making; patient decisions and high-risk factors such as functional status (IADL or ADL), malnutrition, and cognitive or mobility impairment are more important [37].…”

Chemotherapy and Targeted Agents in the Treatment of Elderly Patients with Metastatic Colorectal Cancer

“…The CRASH and CARG tools can be extrapolated and useful for the determination of frailty and the risk of toxicity of chemotherapy in mCRC; although their validation studies did not specifically address for these cases, they included many patients in whom the cancer origin was intestinal (12% and 27% respectively). Recently, a model has been proposed to predict the risk of developing toxicity and early death in chemotherapy-treated colon cancer patients [ 36 ]. However, this model has not yet been validated.…”

“…GA can be a very useful tool to achieve this objective. Moreover, there are other tools that can predict the risk of developing severe chemotherapy toxicity [ 32 , 33 , 36 , 90 , 91 ]. Conducting the GA is very useful not only before starting the treatment but also during or at the end of the chemotherapy in order to evaluate the impact of the treatment on health.…”