Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study

Hurria, Arti; Togawa, Kayo; Mohile, Supriya G.; Owusu, Cynthia; Klepin, Heidi D.; Gross, Cary P.; Lichtman, Stuart M.; Gajra, Ajeet; Bhatia, Smita; Katheria, Vani; Klapper, Shira; Hansen, Kurt; Ramani, Rupal; Lachs, Mark; Wong, F. Lennie; Tew, William P.

doi:10.1200/jco.2011.34.7625

Cited by 1,841Frailty in Older AdultsNutrition and Health in AgingPharmaceutical Practices and Patient Outcomes

Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study

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Hurria, Arti, Togawa, Kayo, Mohile, Supriya G., Owusu, Cynthia, Klepin, Heidi D., Gross, Cary P., Lichtman, Stuart M., Gajra, Ajeet +8 more·2011·Journal of Clinical Oncology

DOI 10.1200/jco.2011.34.7625PMC PMC3624700

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Abstract

Purpose: Older adults are vulnerable to chemotherapy toxicity; however, there are limited data to identify those at risk. The goals of this study are to identify risk factors for chemotherapy toxicity in older adults and develop a risk stratification schema for chemotherapy toxicity. Patients and Methods: Patients age ≥ 65 years with cancer from seven institutions completed a prechemotherapy assessment that captured sociodemographics, tumor/treatment variables, laboratory test results, and geriatric assessment variables (function, comorbidity, cognition, psychological state, social activity/support, and nutritional status). Patients were followed through the chemotherapy course to capture grade 3 (severe), grade 4 (life-threatening or disabling), and grade 5 (death) as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events. Results: In total, 500 patients with a mean age of 73 years (range, 65 to 91 years) with stage I to IV lung (29%), GI (27%), gynecologic (17%), breast (11%), genitourinary (10%), or other (6%) cancer joined this prospective study. Grade 3 to 5 toxicity occurred in 53% of the patients (39% grade 3, 12% grade 4, 2% grade 5). A predictive model for grade 3 to 5 toxicity was developed that consisted of geriatric assessment variables, laboratory test values, and patient, tumor, and treatment characteristics. A scoring system in which the median risk score was 7 (range, 0 to 19) and risk stratification schema (risk score: percent incidence of grade 3 to 5 toxicity) identified older adults at low (0 to 5 points; 30%), intermediate (6 to 9 points; 52%), or high risk (10 to 19 points; 83%) of chemotherapy toxicity (P < .001). Conclusion: A risk stratification schema can establish the risk of chemotherapy toxicity in older adults. Geriatric assessment variables independently predicted the risk of toxicity.

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Older patients with low-risk disease may safely forgo breast radiotherapy.
“For older patients with low-risk disease, breast radiotherapy can be safely omitted [69,70].”
From Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group (2020) · cites this paper as [69]
The analysis adjusted the association between frailty and outcomes for risk group determined by the previously reported toxicity risk calculator.
“we also adjusted the association of frailty with outcomes, by risk group as determined by the calculator.(11)”
From Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy (2016) · cites this paper as [11]

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Phase 2 study of frontline brentuximab vedotin monotherapy in Hodgkin lymphoma patients aged 60 years and older
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Systemic, perioperative management of muscle-invasive bladder cancer and future horizons
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Decline in Cognitive Function in Older Adults With Early-Stage Breast Cancer After Adjuvant Treatment
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Decision Making in Older Adults With Cancer
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Geriatric assessment is associated with completion of chemotherapy, toxicity, and survival in older adults with cancer
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1375P Predicting chemotherapy toxicity in elderly patients with advanced non-small cell lung cancer: A prospective multicenter study of the national hospital organization in Japan
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Batlle, J. F., Basterretxea, L., Torregrosa, M. D., Llabrés, E., Vila, B. L., Jiménez-Munárriz, B., Rebollo, M. A., Custodio, A., Gironés, R., Cruz, P., et al. (2019) · Journal of Clinical Oncology · doi:10.1200/jco.2019.37.15_suppl.11509 · Cited by 4 · see citing works
Predicting Risk of Severe Toxicity and Early Death in Older Adult Patients Treated with Chemotherapy
Feliú, J., Custodio, A., Pinto-Marín, Á., Higuera, O., Pérez-González, M., del Pino, L., Ruiz-Jiménez, L., Sánchez-Cabero, D., Viera, I., Jurado, A., et al. (2023) · Cancers · doi:10.3390/cancers15184670 · Cited by 7 · see citing works

Authors: Hurria, A., Togawa, K., Mohile, S. G., Owusu, C., Klepin, H. D., Gross, C. P., Lichtman, S. M., Gajra, A., Bhatia, S., Katheria, V., Klapper, S., Hansen, K., Ramani, R., Lachs, M., Wong, F. L., & Tew, W. P.
Affiliations: City Of Hope National Medical Center (US)
Arti Hurria, Kayo Togawa, Smita Bhatia, Rupal Ramani, and F. Lennie Wong, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte; Kurt Hansen, University of California Davis School of Medicine, Sacramento, CA; Supriya G. Mohile, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, Shira Klapper, and William P. Tew, Memorial Sloan-Kettering Cancer Center; Mark Lachs, Weill Cornell Medical College, New York; Ajeet Gajra, State University of New York Upstate...
ORCID: Hurria, Arti
Togawa, Kayo
Mohile, Supriya G.
Owusu, Cynthia
Klepin, Heidi D.
Gross, Cary P.
Lichtman, Stuart M.
Gajra, Ajeet
Katheria, Vani
Lachs, Mark
Wong, F. Lennie
Tew, William P.
Venue: Journal of Clinical Oncology
Publisher: American Society of Clinical Oncology (ASCO)
Published: 2011-09-01
Volume: 29
Issue: 25
Pages: 3457-3465
ISSN: 0732-183X (ISSN-L)
1527-7755
DOI: 10.1200/jco.2011.34.7625
PMC: PMC3624700
OpenAlex: W2153294383
Cited by: 1,841
References: 43
Citations by year: 2026: 98 · 2025: 98 · 2024: 117 · 2023: 119 · 2022: 153 · 2021: 149 · 2020: 148 · 2019: 147 · 2018: 143 · 2017: 129 · 2016: 134 · 2015: 114 · 2014: 112 · 2013: 87 · 2012: 73
FWCI: 43.61
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of Clinical Oncology (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Amgen
GlaxoSmithKline
American Society of Clinical Oncology
Celgene
Genentech
National Institute on Aging (K24AG022399, 1K08 AG 24842, K08AG024842, K23AG038361, K23AG026749)
National Cancer Institute (U10CA098543)
Topics: Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords: chemotherapy toxicity, older adults, geriatric assessment, risk stratification, risk prediction model, comorbidities, functional status, nutritional status, cognitive status, laboratory parameters, geriatric oncology
MeSH terms: Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Neoplasms, Predictive Value of Tests, Prospective Studies, Comorbidity, Survival Rate

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Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study

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