Prognostic role of a comprehensive geriatric assessment on the management of elderly patients with advanced non-small cell lung cancer (NSCLC): a pooled analysis of two prospective phase II trials by the GFPC Group

Caer, H. Le; Borget, Isabelle; Corre, Romain; Locher, C.; Raynaud, C.; Decroisette, C.; Bérard, H.; Audigier-Valette, Clarisse; Dujon, C.; Auliac, Jean Bernard; Crequit, Jacquy; Monnet, I.; Vergnenègre, A.; Chouaïd, C.

doi:10.21037/jtd.2017.09.51

Cited by 11 publications

(33 citation statements)

References 31 publications

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“…The 30-day mortality might be unexpectedly high due to our inability to properly identify patients with a poor short-term prognosis. For individual decision making, better prognostic models are needed, including parameters on comorbidity and performance score [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…In our series, 6 years of data were needed to detect three outliers and, hence, 30-day mortality does not appear to be a promising quality parameter at hospital level. It does not fulfil the criteria for a worthwhile parameter, able to discriminate good from poor quality of care [ 15 ]. Such a parameter should be sensitive, needs to be robust, accurate, easily reproducible and interpretable, and validated in the relevant setting.…”

Section: Discussionmentioning

confidence: 99%

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30-day mortality after the start of systemic anticancer therapy for lung cancer: is it really a useful performance indicator?

Burgers

Damhuis

2018

ERJ Open Res

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Systemic treatment is the standard treatment for unresectable stage III and IV lung cancer. Nevertheless, a 5–10% death rate has been described within 30 days after the last systemic treatment, suggesting that these patient did not benefit. We analysed the 30-day mortality after start of systemic therapy.Data were retrieved from the Netherlands National Cancer Registry. From 2010 to 2015, 26 277 patients were included. 56% were men. The median age was 65 years and 31% of patients were aged ≥70 years. 27% involved small cell lung cancer and 73% nonsmall cell lung cancer. Overall mortality within 30 days after the start of systemic treatment was 6.2%. Multivariable analysis established the prognostic influence of age, histology, number of metastatic sites and type of systemic treatment. Chemotherapy was administered in 77 hospitals, treating each 15–161 lung cancer patients with systemic therapy annually. None of the hospitals had a significantly higher 30-day mortality according to hierarchical multivariable analysis, controlling for case-mix.In the Netherlands, the 30-day mortality rate after start of systemic therapy for lung cancer patients was comparable with earlier reports. Hospital volume did not influence the 30-day mortality rate. 30-day mortality rate is not a meaningful indicator to monitor quality of care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

30-day mortality after the start of systemic anticancer therapy for lung cancer: is it really a useful performance indicator?

Burgers

Damhuis

2018

ERJ Open Res

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“…In this respect, structured evaluation with instruments such as the Comprehensive Geriatric Assessment may be useful. 32 , 33 …”

Section: Discussionmentioning

confidence: 99%

Nivolumab treatment in advanced non-small cell lung cancer: real-world long-term outcomes within overall and special populations (the UNIVOC study)

et al. 2020

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Objective: To describe long-term outcomes of patients treated with nivolumab for advanced non-small cell lung cancer (aNSCLC) in everyday clinical practice in France, with a focus on patients aged ⩾80 years, patients with renal impairment and patients with brain metastases. Methods: The study included all patients with aNSCLC recorded in the French national hospital database, starting nivolumab in 2015–2016 and followed until December 2018. Patients were stratified by age, the presence of renal impairment and brain metastasis, as documented in the hospital discharge summaries. Information was retrieved on demographics, comorbidities and treatment history at baseline. Time to discontinuation of nivolumab treatment and overall survival were estimated using Kaplan–Meier survival analysis. Results: Overall, 10,452 patients were included, of whom 514 were octogenarians, 479 had renal impairment and 1800 had brain metastases at baseline. Median duration of nivolumab treatment was 2.8 months in the overall population and in both the octogenarian and renally impaired subgroups, and 2.3 months in patients with brain metastases. Median overall survival in these patient groups was 11.7 months (95% confidence interval: 11.3–12.2), 11.7 months (11.3–12.1), 11.7 months (11.3–12.2) and 9.9 months (9.0–10.9) respectively. Three-year overall survival rates were 19.1% (18.1–20.2) in the overall population, 16.5% (11.6–23.4) in octogenarians, 15.9% (11.8–21.4) in patients with renal impairment and 21.7% (19.4–24.2) in those with brain metastases. Conclusion: This large nationwide retrospective real-life cohort provided narrow estimates of long-term overall survival, which reached 19% at 3 years, consistent with data from phase III trials of nivolumab. Survival rates were comparable in the three special populations of interest and the overall population.

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“…Sixty-four percent of these patients were found to be able to complete their prescribed chemotherapy protocols which is remarkable. 6 This underscores the fact that it is imperative to understand the specific challenges and opportunities in treatment of elderly, preferably with help from geriatric assessment tools to offer optimal therapy in this population.…”

Section: Introductionmentioning

confidence: 99%

Management of Metastatic Nonsmall Cell Lung Cancer in Elderly

Sheth

Kumar

Limaye

2021

Indian J Med Paediatr Oncol

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There is limited data on management of metastatic nonsmall cell lung cancer (NSCLC) in the elderly population due to lack of representation of this subset in clinical trials. The projected representation of elderly population of patients globally is expected to rise significantly in the years to come. It is imperative to understand the specific challenges and opportunities in management of elderly with NSCLC. Even in the elderly, the medical management of advanced NSCLC begins with driver mutation testing on lung biopsy. Once the patient is classified as driver mutation positive or negative, they can either be treated with a single-agent-targeted therapy or with immunotherapy and chemotherapy or after programmed death ligand 1 (PDL-1) assessment, with immunotherapy alone. After starting the appropriate therapy, the disease needs to be monitored at every 3 months with reassessment scans. Treatment in elderly should be designed as per their functional and not chronological age, and geriatric assessment scales should be utilized wherever possible to understand the functional age of the patient.

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Prognostic role of a comprehensive geriatric assessment on the management of elderly patients with advanced non-small cell lung cancer (NSCLC): a pooled analysis of two prospective phase II trials by the GFPC Group

Cited by 11 publications

References 31 publications

30-day mortality after the start of systemic anticancer therapy for lung cancer: is it really a useful performance indicator?

30-day mortality after the start of systemic anticancer therapy for lung cancer: is it really a useful performance indicator?

Nivolumab treatment in advanced non-small cell lung cancer: real-world long-term outcomes within overall and special populations (the UNIVOC study)

Management of Metastatic Nonsmall Cell Lung Cancer in Elderly

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