Publikation: Zeitschriftenartikel

Neglected geriatric assessment and overtreatment of older patients with pancreatic cancer

Grunddaten
Abstract
Autoren
Einrichtung

Grunddaten

Titel	Neglected geriatric assessment and overtreatment of older patients with pancreatic cancer
Untertitel	results from a prospective phase IV clinical trial
Erscheinungsjahr	2022
Seiten (von – bis)	662 – 666
Band	13
Heft-Nr.	5
Jahr	2022
Publikationsform	Elektronische Ressource
Publikationsart	Zeitschriftenartikel
Sprache	Englisch
DOI	10.1016/j.jgo.2021.12.018
Letzte Änderung	14.07.2022 06:01:59
Bearbeitungsstatus	durch UB Rostock abschließend validiert
Dauerhafte URL	http://purl.uni-rostock.de/fodb/pub/68270
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Abstract

Background - Older patients with metastatic pancreatic cancer may suffer increased toxicity from intensive chemotherapy. Treatment individualization by geriatric assessment (GA) might improve functional outcome. - Methods - We performed a multicenter, phase IV, open label trial in patients 70 years with metastatic pancreatic adenocarcinoma. Patients underwent GA and were assigned to one of three categories based on their scores: Go-Go, Slow-Go, or Frail. These categories were intended to guide physician's treatment decisions when choosing to treat patients with nab-paclitaxel/gemcitabine (arm A), gemcitabine (arm B), or best supportive care (arm C). Primary objective was a stable (loss of five points or less) Barthel's Activities of Daily Living (ADL) score during chemotherapy; secondary endpoints included GA scores during therapy, safety, quality of life, response and survival rates. - Results - Thirty-two patients were enrolled in the trial in six centers in Germany (out of 135 planned), resulting in termination due to low recruitment. Fifteen patients were allocated to nab-paclitaxel/gemcitabine, fifteen to gemcitabine, and two to best supportive care by their physicians, although according to their GA scores 29 patients (91%) were categorized as Slow-Go and three (9%) as Go-Go. Thus, fifteen of 32 (47%) patients were misclassified and given a course of treatment inconsistent with their GA scores. Median progression-free survival (PFS) were 3.3 months and 9.1 months and median time to quality-of-life deterioration 13 days and 29 days in the nab-paclitaxel/gemcitabine and gemcitabine monotherapy arms, respectively. Serious adverse events were reported in 11 (78.6%) patients in the nab-paclitaxel/gemcitabine and 8 (53.3%) patients in the gemcitabine arm. - Conclusions - Clinical evaluations by investigators differed markedly from geriatric assessments, leading to potential overtreatment. In our modest sample size study, those patients undergoing more intensive therapy had a less favorable course.

Autoren

Betge, Johannes

Schulte, Nadine

Belle, Sebastian

Zhan, Tianzuo

Krammer-Steiner, Beate

Moulin, Jean-Charles

Kleiß, Matthias

Lammert, Frank

Wedding, Ulrich

Räth, Sebastian

Maenz, Martin

Hegele, Lisa

Larcher-Senn, Julian

Jesenofsky, Ralf

Ebert, Matthias

Härtel, Nicolai

Einrichtung

UMR/ZIM/Klinik und Poliklinik für Innere Medizin III