First-cycle chemo modifications common among older adults with advanced cancer

Treatment modification at the first cycle is common among elderly adults with advanced cancer, a recent study has found. Factors contributing to such a need include increasing age, lower income, and functional impairment.

The study included 369 patients enrolled from the GAP70+ Trial. All participants were aged ≥70 years, had advanced cancer, and had impairments in ≥1 domain of the Geriatric Assessment (GA). Treatment modification was defined as any deviation from treatment guidelines set by the National Comprehensive Cancer Network of the USA or published clinical trials.

Sixty-five percent (n=240) of participants received standard treatment regimens at the first cycle, in keeping with guideline or literature recommendations, while the remaining 35.0 percent (n=129) saw treatment modifications at the first cycle. The most common of such modifications was dose reduction (79 percent; n=292), followed by changing agent combinations and modified medication schedules.

Cluster-weighted multivariable generalized estimating equation models showed that increasing age was a significant predictor for treatment modifications at the first cycle. In particular, each additional year conferred an 8-percent increase in such likelihood (odds ratio [OR], 1.08, 95 percent confidence interval [CI], 1.02–1.15).

Other significant predictors included having impaired functional status (OR, 1.57, 95 percent CI, 1.08–2.27), receiving second or higher lines of chemotherapy (OR, 1.79, 95 percent CI, 1.08–2.95), and low income (OR, 1.67, 95 percent CI, 1.07–2.43).

“The rate of treatment modification in this population emphasizes the importance of developing evidence-based treatment regimens for older adults with advanced cancer and GA impairments,” the researchers said. “Future studies should evaluate the longitudinal effect of cycle 1 treatment modifications in the advanced cancer setting on both cancer and patient-reported outcomes.”