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External Validation of a Prediction Tool for Chemotherapy Toxicity in Older Patients With Cancer

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Key Points

  • The prediction model for chemotherapy toxicity in cancer patients aged ≥ 65 years includes age, planned treatment, tumor characteristics, lab values, and geriatric assessment items.
  • The tool distinguished low, medium, and high risk for grade ≥ 3 toxicity.

Hurria et al validated a prediction tool for chemotherapy toxicity in cancer patients aged ≥ 65 years in an external cohort, according to a report in the Journal of Clinical Oncology. The predictive model had been developed in a prior study in 500 patients.

Study Details

The study involved 250 patients with solid tumors who were scheduled to receive a new chemotherapy regimen at 8 institutions; patients had a mean age of 73 years. Risk for grade ≥ 3 toxicity was calculated on the basis of scoring on several items: age (≥ 72 years = 2 points, < 72 years = 0 points), cancer type (gastrointestinal or genitourinary = 2, others = 0), planned chemotherapy dose (standard dose = 2, dose reduced upfront = 0), planned number of drugs (polychemotherapy = 2, monotherapy = 0), hemoglobin (< 11/ < 10 g/dL in men/women = 3, higher values = 0), creatinine clearance (< 34 mL/min = 3, higher values = 0), hearing (fair or worse = 2, good or better = 0), ability to take own medicine (without help = 0, other = 1), health limitation on walking one block (no limitation = 0, other = 2), and interference of health or emotional problems with social activities in past 4 weeks (no or little limitation = 0, other = 1). Risk level was defined as low = 0–5 points, medium = 6–9 points, and high = 10–19 points.

Predictive Ability

Overall, 24% of patients were at low risk, 53% were at intermediate risk, and 23% were at high risk. Grade ≥ 3 toxicity occurred in 58% of patients. The risk of toxicity was 36.7%, 62.4%, and 70.2% in the low-, medium-, and high-risk groups (P < .001). The area under the curve of the receiver-operating characteristic curve was 0.65 (95% confidence interval [CI] = 0.58–0.71), which did not differ significantly from that in the development cohort (0.72, 95% CI = 0.68–0.77; P = .09). There was no significant association between Karnofsky performance status and toxicity (P = .25).

The investigators concluded: “This study externally validated a chemotherapy toxicity predictive model for older adults with cancer. This predictive model should be considered when discussing the risks and benefits of chemotherapy with older adults.”

The study was supported by the National Institutes of Health, the National Institute on Aging, the Paul Beeson Career Development Award in Aging Research, and ASCO.

Arti Hurria, MD, of the City of Hope Comprehensive Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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