Geriatric Factors Predict Chemotherapy Feasibility: Ancillary Results of FFCD 2001-02 Phase III Study in First-Line Chemotherapy for Metastatic Colorectal Cancer in Elderly Patients

被引：165

作者：

Aparicio, Thomas ^{[1
]}

Jouve, Jean-Louis ^{[4
]}

Teillet, Laurent ^{[2
]}

Gargot, Dany ^{[6
]}

Subtil, Fabien ^{[5
]}

Le Brun-Ly, Valerie ^{[7
]}

Cretin, Jacques ^{[8
]}

Locher, Christophe ^{[9
]}

Bouche, Olivier ^{[10
]}

Breysacher, Gilles ^{[11
]}

Charneau, Jacky ^{[12
]}

Seitz, Jean-Francois ^{[13
]}

Gasmi, Mohamed ^{[14
]}

Stefani, Laetitia ^{[15
]}

Ramdani, Mohamed ^{[16
]}

Lecomte, Thierry ^{[17
]}

Mitry, Emmanuel ^{[3
]}

机构：

[1] Univ Paris 13, Avicenne Hosp, AP HP, Sorbonne Paris Cite, F-93000 Bobigny, France

[2] St Perine Hosp, AP HP, Paris, France

[3] Versaille St Quentin Univ, Inst Curie, Paris, France

[4] Ctr Hosp Univ CHU Dijon, Dijon, France

[5] Federat Francophone Cancerol Digest, Dijon, France

[6] Ctr Hosp CH Blois, Blois, France

[7] CHU Limoges, Limoges, France

[8] CH Ales, Ales, France

[9] CH Meaux, Meaux, France

[10] CHU Robert Debre, Reims, France

[11] CH Colmar, Colmar, France

[12] CH Boulogne Sur Mer, Boulogne Sur Mer, France

[13] Timone Hosp, AP HM, Marseille, France

[14] Hop Nord Marseille, AP HM, Marseille, France

[15] CH Pringy, Pringy, France

[16] CH Bezier, Bezier, France

[17] Univ Tours, CHU Trousseau, Tours, France

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2013年 / 31卷 / 11期

关键词：

QUALITY-OF-LIFE; OLDER PATIENTS; DECISION-MAKING; SURVIVAL; AGE; FLUOROURACIL; OXALIPLATIN; SURVEY-13; TOXICITY;

D O I：

10.1200/JCO.2012.42.9894

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose Elderly patients form a heterogeneous population. Evaluation of geriatric factors may help evaluate a patient's health status to better adapt treatment. Patients and Methods Elderly patients with previously untreated metastatic colorectal cancer (mCRC) were randomly assigned to receive fluorouracil (FU) -based chemotherapy either alone or in combination with irinotecan (IRI) in the Federation Francophone de Cancerologie Digestive (FFCD) 2001-02 study. Sites participating in the geriatric substudy completed geriatric screening tools to perform prognostic factor analyses for treatment safety during the first 4 months after treatment initiation. Results The geriatric score was calculated in 123 patients (44%). Median age was 80 years (range, 75 to 91 years). The Charlson comorbidity index was <= 1 in 75%, Mini-Mental State Examination (MMSE) score was <= 27/30 in 31%, and Instrumental Activities of Daily Living (IADL) showed impairment in 34% of the patients. Seventy-one patients (58%) had grade 3 to 4 toxicity, 41 (33%) had a dose-intensity reduction of more than 33%, and 54 (44%) had at least one unexpected hospitalization during the first 4 months after starting treatment. In multivariate analysis, significant predictive factors for grade 3-4 toxicity were IRI arm (odds ratio [OR], 5.03), MMSE <= 27/30 (OR, 3.84), and impaired IADL (OR, 4.67); for dose-intensity reduction of > 33%, the significant predictive factors were alkaline phosphates > 2 x upper limit of normal (OR, 4.16) and IRI arm (OR, 6.85); and for unexpected hospitalization, significant predictive factors were MMSE <= 27/30 (OR, 4.56) and Geriatric Depression Scale <= 2 (OR, 5.52). Conclusion Geriatric factors (MMSE and IADL) are predictive of severe toxicity or unexpected hospitalization (MMSE) in a randomized prospective phase III study in mCRC. These results suggest that cognitive function and autonomy impairment should be taken into account when choosing a regimen for chemotherapy. J Clin Oncol 31:1464-1470. (C) 2013 by American Society of Clinical Oncology

引用

页码：1464 / 1470

页数：7

共 30 条

[1] Oxaliplatin- or irinotecan-based chemotherapy for metastatic colorectal cancer in the elderly [J].