No Treatment Failure or Survival Benefit but Less Toxicity With Comprehensive Geriatric Assessment in Elderly Patients With Advanced NSCLC
Use of comprehensive geriatric assessment to guide therapy in elderly patients with stage IV non–small cell lung cancer (NSCLC) did not improve treatment failure–free or overall survival but was associated with slightly reduced toxicity, based on the results of the phase III ESOGIA-GFPC-GECP 08-02 trial reported by Corre et al in the Journal of Clinical Oncology.
Study Details
In this open-label trial, 494 patients from 45 sites in France and Spain aged ≥ 70 years and with Eastern Cooperative Oncology Group performance status of 0 to 2 were randomly assigned between January 2010 and January 2013 to a standard chemotherapy group (n = 251) with treatment assigned on the basis of age and performance status or a comprehensive geriatric assessment group (n = 243) with treatment assigned on the basis of comprehensive geriatric assessment of fit, vulnerable, or frail. Patients in the standard group with a performance status ≤ 1 and age ≤ 75 years received a carboplatin-based doublet, and those with a performance status of 2 or age > 75 years received docetaxel. In the comprehensive geriatric assessment group, fit patients received a carboplatin-based doublet, vulnerable patients received docetaxel, and frail patients received best supportive care. The primary endpoint was treatment failure–free survival.
Outcomes
Median age among all patients was 77 years. In the standard and comprehensive geriatric assessment groups, 35% and 46% of patients received a carboplatin-based doublet, 65% and 31% received docetaxel, and 0% and 23% received best supportive care. Median treatment failure–free survival was 3.2 vs 3.1 months (hazard ratio [HR] = 0.91, P = .32), median progression-free survival was 3.7 vs 3.4 months (P = .59), and median overall survival was 6.4 vs 6.1 months (HR = 0.92, P = .87).
Toxicity
Patients in the comprehensive geriatric assessment group had a lower incidence of any-grade adverse events (85.6% vs 93.4%, P = .015), including a lower rate of grade 3 or 4 thrombocytopenia (3.6% vs 7.8%, P = .04) and fewer treatment failures due to toxicity (4.8% vs 11.8%, P = .007). Overall, there was no significant difference in the incidence of grade 3 or 4 toxicity (67.9% in the comprehensive geriatric assessment group vs 71.3% in the standard group, P = .41).
The investigators concluded: “In elderly patients with advanced NSCLC, treatment allocation on the basis of comprehensive geriatric assessment failed to improve the [treatment failure-free survival] or [overall survival] but slightly reduced treatment toxicity.
The study was supported by Eli Lilly, Sanofi, Roche, and Chugai.
Romain Corre, MD, of Centre Hospitalier Universitaire de Rennes, is the corresponding author of the Journal of Clinical Oncology article.
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