Predicting Chemotherapy Toxicity in Older Patients with Cancer: A Multicenter Prospective Study.
Chemotherapy
Geriatric assessment
Older patient
Toxicity
Toxicity risk score
Journal
The oncologist
ISSN: 1549-490X
Titre abrégé: Oncologist
Pays: England
ID NLM: 9607837
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
13
09
2019
accepted:
24
03
2020
pubmed:
25
4
2020
medline:
22
6
2021
entrez:
25
4
2020
Statut:
ppublish
Résumé
Standard oncology tools are inadequate to distinguish which older patients are at higher risk of developing chemotherapy-related complications. Patients over 70 years of age starting new chemotherapy regimens were prospectively included in a multicenter study. A prechemotherapy assessment that included sociodemographics, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and the development of grade 3-5 toxicity was examined by using logistic regression. A total of 551 patients were accrued. Chemotherapy doses (odds ratio [OR] 1.834; 95% confidence interval [CI] 1.237-2.719) and creatinine clearance (OR 0.989; 95% CI 0.981-0.997) were the only factors independently associated with toxicity. Only 19% of patients who received reduced doses of chemotherapy and had a creatinine clearance ≥40 mL/minute had grade 3-4 toxicity, compared with 38% of those who received standard doses or had a creatinine clearance <40 mL/minute (p < .0001). However, no satisfactory multivariate model was obtained using different selection approaches. Chemotherapy doses and renal function were identified as the major risk factors for developing severe toxicity in the older patient. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up in these patients. Older patients are more vulnerable to chemotherapy toxicity. However, standard tools are inadequate to identify who is at higher risk of developing chemotherapy-related complications. Chemotherapy doses (standard vs. reduced) and renal function were identified as the major risk factors for developing severe toxicity in the elderly. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up.
Sections du résumé
BACKGROUND
Standard oncology tools are inadequate to distinguish which older patients are at higher risk of developing chemotherapy-related complications.
MATERIALS AND METHODS
Patients over 70 years of age starting new chemotherapy regimens were prospectively included in a multicenter study. A prechemotherapy assessment that included sociodemographics, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and the development of grade 3-5 toxicity was examined by using logistic regression.
RESULTS
A total of 551 patients were accrued. Chemotherapy doses (odds ratio [OR] 1.834; 95% confidence interval [CI] 1.237-2.719) and creatinine clearance (OR 0.989; 95% CI 0.981-0.997) were the only factors independently associated with toxicity. Only 19% of patients who received reduced doses of chemotherapy and had a creatinine clearance ≥40 mL/minute had grade 3-4 toxicity, compared with 38% of those who received standard doses or had a creatinine clearance <40 mL/minute (p < .0001). However, no satisfactory multivariate model was obtained using different selection approaches.
CONCLUSION
Chemotherapy doses and renal function were identified as the major risk factors for developing severe toxicity in the older patient. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up in these patients.
IMPLICATIONS FOR PRACTICE
Older patients are more vulnerable to chemotherapy toxicity. However, standard tools are inadequate to identify who is at higher risk of developing chemotherapy-related complications. Chemotherapy doses (standard vs. reduced) and renal function were identified as the major risk factors for developing severe toxicity in the elderly. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up.
Identifiants
pubmed: 32329131
doi: 10.1634/theoncologist.2019-0701
pmc: PMC7543241
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1516-e1524Informations de copyright
© AlphaMed Press 2020.
Références
Br J Clin Pharmacol. 2019 Jul;85(7):1507-1515
pubmed: 30941789
J Geriatr Oncol. 2015 Jul;6(4):272-9
pubmed: 26088748
Ann Oncol. 1991 Jun;2(6):437-9
pubmed: 1768630
Crit Rev Oncol Hematol. 2011 May;78(2):138-49
pubmed: 20444620
J Am Geriatr Soc. 1968 May;16(5):622-6
pubmed: 5646906
J Gerontol. 1994 Mar;49(2):M85-94
pubmed: 8126356
Drugs Aging. 2005;22(9):785-91
pubmed: 16156682
Ann Oncol. 2005 Nov;16(11):1795-800
pubmed: 16093275
N Engl J Med. 1995 Mar 2;332(9):556-61
pubmed: 7838189
Ann Oncol. 2015 Apr;26(4):715-724
pubmed: 25595934
J Am Geriatr Soc. 1975 Oct;23(10):433-41
pubmed: 1159263
JAMA. 1963 Sep 21;185:914-9
pubmed: 14044222
J Clin Oncol. 2005 Oct 1;23(28):6865-72
pubmed: 16192578
Gerontologist. 1969 Autumn;9(3):179-86
pubmed: 5349366
Soc Sci Med. 1999 Jun;48(12):1721-34
pubmed: 10405011
J Clin Oncol. 2013 Apr 10;31(11):1464-70
pubmed: 23460711
J Geriatr Oncol. 2013 Oct;4(4):334-9
pubmed: 24472476
Ann Oncol. 2014 Oct;25(10):1914-1918
pubmed: 24569912
Crit Rev Oncol Hematol. 2018 Nov;131:16-23
pubmed: 30293701
J Natl Cancer Inst. 2002 Feb 6;94(3):173-81
pubmed: 11830607
J Clin Oncol. 2002 Mar 1;20(5):1192-202
pubmed: 11870160
Acta Psychiatr Scand. 1983 Jun;67(6):361-70
pubmed: 6880820
J Geriatr Oncol. 2019 Mar;10(2):202-209
pubmed: 30224184
J Geriatr Oncol. 2017 Mar;8(2):96-101
pubmed: 27856262
Cancer. 2012 Jul 1;118(13):3377-86
pubmed: 22072065
Acta Oncol. 2016 Jan;55(1):15-23
pubmed: 26271800
J Clin Oncol. 2008 Nov 20;26(33):5386-92
pubmed: 18955446
CA Cancer J Clin. 2016 Jan-Feb;66(1):7-30
pubmed: 26742998
Nephron. 1976;16(1):31-41
pubmed: 1244564
Stat Med. 2016 Jan 30;35(2):214-26
pubmed: 26553135
Radiology. 1982 Apr;143(1):29-36
pubmed: 7063747
J Clin Oncol. 2018 Aug 1;36(22):2326-2347
pubmed: 29782209
J Clin Oncol. 2010 Apr 20;28(12):2046-50
pubmed: 20308657
Eur J Cancer. 1999 Nov;35(12):1640-9
pubmed: 10674007
Eur J Cancer. 2002 Jul;38(11):1466-73
pubmed: 12110492
Br J Cancer. 2018 May;118(9):1169-1175
pubmed: 29576622
J Clin Oncol. 2011 Sep 1;29(25):3457-65
pubmed: 21810685
J Clin Oncol. 2016 Jul 10;34(20):2366-71
pubmed: 27185838
Cancer. 1998 Jun 1;82(11):2123-34
pubmed: 9610691
Eur J Cancer. 2004 May;40(8):1193-8
pubmed: 15110883
Lancet. 1971 May 8;1(7706):975-6
pubmed: 4102307
Med Clin (Barc). 2007 May 12;128(18):687-91
pubmed: 17540143
Oncologist. 2018 May;23(5):573-579
pubmed: 29371477