Assessment and correction of the geriatric status of patients with metastatic colorectal cancer during the first-line systemic therapy
- Authors: Alekseeva Y.V.1, Semiglazova T.Y.1,2, Sharashenidze S.M.1, Tkachenko E.V.1, Kasparov B.S.1, Brish N.A.1, Teletaeva G.M.1, Filatova L.V.1,2, Sluzhev M.I.1,3, Semiglazov V.V.1,3, Protsenko S.A.1, Belyaev A.M.1,2
-
Affiliations:
- Petrov National Medical Research Centre of Oncology
- Mechnikov North-Western State Medical University
- Pavlov First Saint Petersburg State Medical University
- Issue: Vol 23, No 1 (2021)
- Pages: 133-140
- Section: CLINICAL ONCOLOGY
- URL: https://journals.rcsi.science/1815-1434/article/view/70418
- DOI: https://doi.org/10.26442/18151434.2021.1.200754
- ID: 70418
Cite item
Full Text
Abstract
Humanity is rapidly aging, about 50% of all human malignancies develop in people over 65 years old. Cancer and antineoplastic therapy are potential pathophysiological stressors that worsen the course or intensify the development of previously compensated comorbidities and geriatric syndromes. At present, the role of assessment and correction of geriatric syndromes (CGS) for the purpose of effective first-line drug therapy in patients with metastatic CRC in the elderly and senile age, based on the use of a comprehensive geriatric assessment, has not been evaluated.
Aim. Improving the efficiency of the first-line systemic antineoplastic treatment of patients with metastatic colorectal cancer in the elderly and senile age against the background of assessment and correction of the gerontological profile.
Materials and methods. The study included data on 177 patients with metastatic colorectal cancer T1-4N1-2M1 (stage IV) who underwent first-line systemic therapy based on the FOLFOX-6 scheme at the Petrov National Medical Research Centre of Oncology from 2015 to 2021. The prospective group included 59 middle-aged and elderly patients who underwent assessment and CGS on the background of first-line systemic therapy. For analyzing the impact of assessment and CGS on the efficiency (objective response, disease control, event-free survival – EFS) and the toxicity of systemic treatment, a retrospective review of the medical histories of 118 middle-aged and elderly patients who did not undergo assessment and CGS was performed.
Results. Assessment and CGS allows to improve the results of patients with metastatic colorectal cancer, independently of age and treatment regimen: the toxicity is lower in the CGS group, neutropenia grade 3 was absent in the group with CGS, without CGS 10.7 and 14.8% for elderly and middle-aged, respectively; clinically significant response is also better in the group with CGS – 87.8%; without CGS – 69% (p<0.05); the median EFS is 9.9 [8.84–11.08] months in the group with CGS, and 7.2 [4.15–10.24] months without CGS (p=0.02).
Conclusion. In order to improve the efficiency of treatment of patients with metastatic colorectal cancer in the clinical practice of oncologists, it is advisable to conduct a comprehensive geriatric assessment and correction of geriatric syndromes.
Full Text
##article.viewOnOriginalSite##About the authors
Yuliia V. Alekseeva
Petrov National Medical Research Centre of Oncology
Author for correspondence.
Email: dr.alekseevauv@gmail.com
ORCID iD: 0000-0001-5609-1237
Graduate Student
Russian Federation, Saint PetersburgTatiana Y. Semiglazova
Petrov National Medical Research Centre of Oncology; Mechnikov North-Western State Medical University
Email: tsemiglazova@mail.ru
ORCID iD: 0000-0002-4305-6691
D. Sci. (Med.)
Russian Federation, Saint Petersburg; Saint PetersburgSofiko M. Sharashenidze
Petrov National Medical Research Centre of Oncology
Email: sofiko.sharashenidze@gmail.com
ORCID iD: 0000-0002-9842-2951
Clinical Resident
Russian Federation, Saint PetersburgElena V. Tkachenko
Petrov National Medical Research Centre of Oncology
Email: elenatkachen@yandex.ru
Cand. Sci. (Med.)
Russian Federation, Saint PetersburgBoris S. Kasparov
Petrov National Medical Research Centre of Oncology
Email: boriankasparov@mail.ru
ORCID iD: 0000-0003-0341-3823
Cand. Sci. (Med.)
Russian Federation, Saint PetersburgNadezhda A. Brish
Petrov National Medical Research Centre of Oncology
Email: nbrish@list.ru
ORCID iD: 0000-0001-6995-1048
Graduate Student
Russian Federation, Saint PetersburgGulfiia M. Teletaeva
Petrov National Medical Research Centre of Oncology
Email: drteletaeva@yahoo.com
ORCID iD: 0000-0001-9365-8554
Cand. Sci. (Med.)
Russian Federation, Saint PetersburgLarisa V. Filatova
Petrov National Medical Research Centre of Oncology; Mechnikov North-Western State Medical University
Email: larisa_filatova@list.ru
ORCID iD: 0000-0002-0728-4582
D. Sci. (Med.), Prof.
Russian Federation, Saint Petersburg; Saint PetersburgMaksim I. Sluzhev
Petrov National Medical Research Centre of Oncology; Pavlov First Saint Petersburg State Medical University
Email: sluzhemaxim@mail.ru
ORCID iD: 0000-0002-6346-1029
Graduate Student
Russian Federation, Saint Petersburg; Saint PetersburgVladislav V. Semiglazov
Petrov National Medical Research Centre of Oncology; Pavlov First Saint Petersburg State Medical University
Email: ssemiglazov@mail.ru
ORCID iD: 0000-0002-8825-5221
D. Sci. (Med.)
Russian Federation, Saint Petersburg; Saint PetersburgSvetlana A. Protsenko
Petrov National Medical Research Centre of Oncology
Email: s.protsenko@list.ru
ORCID iD: 0000-0001-8704-7669
D. Sci. (Med.)
Russian Federation, Saint PetersburgAleksei M. Belyaev
Petrov National Medical Research Centre of Oncology; Mechnikov North-Western State Medical University
Email: oncl@rion.spb.ru
ORCID iD: 0000-0002-4636-4200
D. Sci. (Med.), Prof.
Russian Federation, Saint Petersburg; Saint PetersburgReferences
- Онкогеронтология: руководство для врачей. Под ред. Анисимова В.Н., Беляева А.М. СПб.: Вопросы онкологии, 2017 [Oncogerontology: A guide for doctors. Eds. Anisimov VN, Belyaev AM. Saint Petersburg: Questions of Oncology, 2017 (in Russian)].
- United Nations, Department of Economic and Social Affairs, Population Division (2020). World Population Ageing 2019 (ST/ESA/SER.A/444).
- Каприн А.Д., Старинский В.В., Шахзадова А.О. Состояние онкологической помощи населению России в 2019 году. М.: МНИОИ им. П.А. Герцена − филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2020 [Kaprin AD, Starinskiy VV, Shahzadova AO. State of cancer care in Russian Federation in 2019. Moscow: National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 2020 (in Russian)].
- Available at: https://gco.iarc.fr/ (GLOBOCAN, 2020).
- Yu M, Hazelton WD, Luebeck GE, Grady WM. Epigenetic Aging: More Than Just a Clock When It Comes to Cancer. Cancer Res 2020; 80 (3): 367–74. doi: 10.1158/0008-5472.CAN-19-0924
- Magnuson A, Sattar S, Nightingale G, et al. A Practical Guide to Geriatric Syndromes in Older Adults With Cancer: A Focus on Falls, Cognition, Polypharmacy, and Depression. Am Soc Clin Oncol Educ Book 2019; 39: 96–109. doi: 10.1200/EDBK_237641
- Руководство по химиотерапии опухолевых заболеваний. Под ред. Переводчиковой Н.И., Горбуновой В.А. 4-е изд. расшир. и доп. М.: Практическая медицина, 2018 [Guidelines for chemotherapy of tumor diseases. Eds. Perevodchikova NI, Gorbunova VA. 4th ed. expanded and supplemented. Moscow: Practical Medicine, 2018 (in Russian)].
- Горелик С.Г. Синдром старческой астении и гериатрические синдромы у возрастных пациентов хирургического профиля. Современные проблемы науки и образования. 2015; 2. Режим доступа: www.science-education.ru/122-17283. Ссылка активна на 29.01.2021 [Gorelik SG. The Syndrome of senile asthenia and geriatric syndromes in elderly patients of a surgical profile. Modern problems of science and education. 2015; 2. Available at: www.science-education.ru/122-17283. Accessed: 29.01.2021 (in Russian)].
- Jayani RV, Magnuson AM, Sun CL, et al. Association between a cognitive screening test and severe chemotherapy toxicity in older adults with cancer. J Geriatr Oncol 2020; 11 (2): 284–9. doi: 10.1016/j.jgo.2019.10.004
- Balducci L, Extermann M. Managment of cancer in older person: practical approach. Oncologist 2000; 5 (3): 224–37. doi: 10.1634/theoncologist.5-3-224
- Gironés Sarrió R, Antonio Rebollo M, Molina Garrido MJ, et al. Spanish Working Group on Geriatric Oncology of the Spanish Society of Medical Oncology (SEOM). General recommendations paper on the management of older patients with cancer: the SEOM geriatric oncology task force’s position statement. Clin Transl Oncol 2018; 20 (10): 1246–51. doi: 10.1007/s12094-018-1856-x
- Repetto L, Fratino L, Audisio RA, et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 2002; 20 (2); 494–502. doi: 10.1634/theoncologist.5-3-224
- Hurria A. Senior adult oncology, version 2.2014. J Natl Compr Cancer Netw 2014; 12: 82–126. doi: 10.6004/jnccn.2014.0009
- NCCN Older Adult Oncology Guidelines Version 1.2020. Available at: https://www.nccn.org/professionals/physician_gls/default.aspx Accessed: 15.01.2021
- Decoster L, Vanacker L, Kenis C, et al. Relevance of Geriatric Assessment in Older Patients With Colorectal Cancer. Clin Colorectal Cancer 2017; 16 (3): 221–9. doi: 10.1016/j.clcc.2016.07.010
- Farrington N, Richardson A, Bridges J. Interventions for older people having cancer treatment: A scoping review. J Geriatr Oncol 2020; 11 (5): 769–83. doi: 10.1016/j.jgo.2019.09.015
- Soto-Perez-de-Celis E, Aapro M, Muss H. ASCO 2020: The Geriatric Assessment Comes of Age. Oncologist 2020; 25 (11): 909–12. doi: 10.1634/theoncologist.2020-0804
- Mohile SG, Mohamed MR, Culakova E, et al. A geriatric assessment (GA) intervention to reduce treatment toxicity in older patients with advanced cancer: A University of Rochester Cancer Center NCI community oncology research program cluster randomized clinical trial (CRCT). J Clin Oncol 2020; 38: 12009a. doi: 10.1200/JCO.2020.38.15_suppl.12009
- Li D, Sun CL, Kim H, et al. Geriatric assessment‐driven intervention (GAIN) on chemotherapy toxicity in older adults with cancer: A randomized controlled trial. J Clin Oncol 2020; 38: 12010a. doi: 10.1200/JCO.2020.38.15_suppl.12010
- Soo WK, King M, Pope A, et al. ELderly Functional Index (ELFI): Validation of a self‐reported measure of functional status in cancer patients. J Clin Oncol 2020; 38: e19126a. doi: 10.1200/JCO.2020.38.15_suppl.e19126