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Neglected geriatric assessment and overtreatment of older patients with pancreatic cancer: results from a prospective phase IV clinical trial

Background - Older patients with metastatic pancreatic cancer may suffer increased toxicity from intensive chemotherapy. Treatment individualization by geriatric assessment (GA) might improve functional outcome. - Methods - We performed a multicenter, phase IV, open label trial in patients ≥70 years...

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Hauptverfasser: Betge, Johannes (VerfasserIn) , Schulte, Nadine (VerfasserIn) , Belle, Sebastian (VerfasserIn) , Zhan, Tianzuo (VerfasserIn) , Krammer-Steiner, Beate (VerfasserIn) , Moulin, Jean-Charles (VerfasserIn) , Kleiß, Matthias (VerfasserIn) , Lammert, Frank (VerfasserIn) , Wedding, Ulrich (VerfasserIn) , Räth, Sebastian (VerfasserIn) , Maenz, Martin (VerfasserIn) , Hegele, Lisa (VerfasserIn) , Larcher-Senn, Julian (VerfasserIn) , Jesenofsky, Ralf (VerfasserIn) , Ebert, Matthias (VerfasserIn) , Härtel, Nicolai (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: June 2022
In: Journal of geriatric oncology
Year: 2022, Jahrgang: 13, Heft: 5, Pages: 662-666
ISSN:1879-4076
DOI:10.1016/j.jgo.2021.12.018
Online-Zugang:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.jgo.2021.12.018
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S1879406821006640
Volltext
Verfasserangaben:Johannes Betge, Nadine Schulte, Sebastian Belle, Tianzuo Zhan, Beate Krammer-Steiner, Jean-Charles Moulin, Matthias Kleiß, Frank Lammert, Ulrich Wedding, Sebastian Räth, Martin Maenz, Lisa Hegele, Julian Larcher-Senn, Ralf Jesenofsky, Matthias P. Ebert, Nicolai Härtel
Beschreibung
Zusammenfassung:Background - Older patients with metastatic pancreatic cancer may suffer increased toxicity from intensive chemotherapy. Treatment individualization by geriatric assessment (GA) might improve functional outcome. - Methods - We performed a multicenter, phase IV, open label trial in patients ≥70 years with metastatic pancreatic adenocarcinoma. Patients underwent GA and were assigned to one of three categories based on their scores: Go-Go, Slow-Go, or Frail. These categories were intended to guide physician's treatment decisions when choosing to treat patients with nab-paclitaxel/gemcitabine (arm A), gemcitabine (arm B), or best supportive care (arm C). Primary objective was a stable (loss of five points or less) Barthel's Activities of Daily Living (ADL) score during chemotherapy; secondary endpoints included GA scores during therapy, safety, quality of life, response and survival rates. - Results - Thirty-two patients were enrolled in the trial in six centers in Germany (out of 135 planned), resulting in termination due to low recruitment. Fifteen patients were allocated to nab-paclitaxel/gemcitabine, fifteen to gemcitabine, and two to best supportive care by their physicians, although according to their GA scores 29 patients (91%) were categorized as Slow-Go and three (9%) as Go-Go. Thus, fifteen of 32 (47%) patients were misclassified and given a course of treatment inconsistent with their GA scores. Median progression-free survival (PFS) were 3.3 months and 9.1 months and median time to quality-of-life deterioration 13 days and 29 days in the nab-paclitaxel/gemcitabine and gemcitabine monotherapy arms, respectively. Serious adverse events were reported in 11 (78.6%) patients in the nab-paclitaxel/gemcitabine and 8 (53.3%) patients in the gemcitabine arm. - Conclusions - Clinical evaluations by investigators differed markedly from geriatric assessments, leading to potential overtreatment. In our modest sample size study, those patients undergoing more intensive therapy had a less favorable course.
Beschreibung:Online verfügbar: 3 January 2022, Artikelversion: 17 June 2022
Gesehen am 08.01.2024
Beschreibung:Online Resource
ISSN:1879-4076
DOI:10.1016/j.jgo.2021.12.018

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