title: Palliative chemotherapy in elderly patients with common metastatic malignancies: A Hellenic Cooperative Oncology Group registry analysis of management, outcome and clinical benefit predictors.
abstract: BACKGROUND
  Cancer in the elderly is a common health issue in developed societies. We sought to present epidemiology, management and outcome data on fit elderly patients with common metastatic cancers and to identify predictors of clinical benefit from palliative chemotherapy.
  
  
  METHODS
  All patients aged >65 years who were diagnosed with metastatic breast, colorectal or non-small cell lung carcinomas and managed with palliative chemotherapy in the context of Hellenic Cooperative Oncology Group (HeCOG) clinical trials or protocols were eligible for electronic data retrieval and analysis. Common eligibility criteria included adequate performance status (ECOG 0-3), organ function and absence of severe co-morbidity forbidding cytotoxic chemotherapy.
  
  
  RESULTS
  One thousand three hundred and seventy-two fit patients (PS 0-1 in 73%) with a median age of 70 years diagnosed with metastatic breast (n=250), colorectal (n=621) or lung cancer (n=501) received chemotherapy from 1991 until 2006. Most patients received modern full-dose chemotherapy regimens including platinum, taxanes, anthracyclines, fluoropyrimidines, oxaliplatin or irinotecan. Mild to moderate co-morbidity was present in 35%. At a median follow-up of 3 years, objective responses were seen in 41% of patients with breast cancer, 25% with colorectal cancer and 31% with lung cancer, while median survival was 21, 16 and 9.4 months, respectively. Grade 3 or 4 toxicity was seen in a quarter of patients, the most common being neutropenia (14%), diarrhoea (6%), neurotoxicity (4%), fatigue, nausea and febrile neutropenia (each 2%). In multivariate analysis, diagnosis of colorectal or lung cancer, metastases in multiple organ sites, presence of liver/brain/peritoneal deposits, impaired PS and low baseline serum albumin levels were prognostic factors for adverse outcome. The same factors excluding metastatic sites and with the addition of anemia predicted for resistance to chemotherapy. Toxicity was more likely in females with low serum albumin and renal dysfunction. A six-variable geriatric assessment for palliation (GAP) score that included tumour type, sites of metastatic dissemination, impaired PS, low serum albumin and anemia classified elderly patients to groups with low, intermediate and high risk for disease progression and death (relative risks of 1.59 and 2.50 for resistance to therapy and 1.87 and 3.12 for death in the intermediate and high-risk groups).
  
  
  CONCLUSIONS
  Our data indicate that relatively fit elderly patients with advanced cancer safely tolerate modern chemotherapy and enjoy disease control in a manner comparable to younger patients. Our GAP score, if further validated, offers promise for geriatric application in combination to comprehensive geriatric assessment tools for the optimisation of palliative therapy on an individualised basis.
authors.affiliation: Department of Medical Oncology, Ioannina University Hospital, Ioannina, Greece. gpenther@otenet.gr
authors.forename: George
authors.initials: G
authors.lastname: Pentheroudakis
authors.forename: George
authors.initials: G
authors.lastname: Fountzilas
authors.forename: Haralabos P
authors.initials: HP
authors.lastname: Kalofonos
authors.forename: Vassilios
authors.initials: V
authors.lastname: Golfinopoulos
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Aravantinos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Bafaloukos
authors.forename: Pavlos
authors.initials: P
authors.lastname: Papakostas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Pectasides
authors.forename: Christos
authors.initials: C
authors.lastname: Christodoulou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Syrigos
authors.forename: Theofanis
authors.initials: T
authors.lastname: Economopoulos
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pavlidis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D009362:Neoplasm Metastasis / Q000188:drug therapy; D010166:Palliative Care; D016896:Treatment Outcome