Outcomes Are Comparable With Treatment Allocation Based on CGA or Performance Status and Age in Elderly Patients with NSCLC
An oncologist reviews test results.
Treatment allocation based on comprehensive geriatric assessment (CGA) did not improve treatment failure free survival (TFFS) or overall survival (OS), but treatment toxicity was slightly reduced, in elderly patients with advanced non-small cell lung cancer (NSCLC), according to a study published online ahead of print in the Journal of Clinical Oncology.1
Assessment of elderly patients' vulnerability using CGA is recommended as a part of cancer treatment decision making; however, this integration has not been prospectively evaluated. In this multicenter, open-label, phase III trial, researchers sought to compare a standard strategy of chemotherapy allocation based on performance status (PS) and age with an experimental strategy based on CGA.
For the study, researchers randomly assigned 494 patients to standard strategy (n=251) or CGA strategy (n=243). The patients were age 70 years and older, median age 77 years, with a PS of 0 to 2 and stage IV NSCLC.
Treatment allocation in the standard arm was carboplatin-based doublet if PS was 1 or lower and age was 75 years or younger; docetaxel if PS was 2 or patient was older than 75 years. Treatment allocation in the CGA arm was carboplatin-based doublet for fit patients, docetaxel for vulnerable patients, and best supportive care for frail patients. The primary end point was treatment failure free survival (TFFS); secondary end points were overall survival (OS), progression-free survival, tolerability, and quality of life.
In the standard arm, 35.1% of patients received a caboplatin-based doublet, 64.9% received docetaxel; no patients received best supportive care. In the CGA arm, 45.7% of patients received a caboplatin-based doublet, 31.3% received docetaxel, and 23% received best supportive care.
In the standard and CGA arms, median TFFS times were 3.2 months in the standard arm and 3.1 months in the CGA arm (hazard ratio, 0.91; 95% CI, 0.76 to 1.1); median OS was 6.4 months in the standard arm and 6.1 months in the CGA arm (hazard ratio, 0.92; 95% CI, 0.79 to 1.1). Significantly less all grade toxicity (85.6% vs 93.4%; P = .015) and fewer treatment failures as a result of toxicity (4.8% vs 11.8%; P = .007) were reported in patients in the CGA arm compared with those in the standard arm, respectively.
1. Corre R, Greillier L, Le Caër H, et al. Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small-cell lung cancer: the phase III randomized ESOGIA-GFPC-GECP 08-02 Study [published online ahead of print February 16, 2016]. J Clin Oncol. doi:10.1200/JCO.2015.63.5839.