Use of a Comprehensive Geriatric Assessment for the Management of Elderly Patients With Advanced Non–Small-Cell Lung Cancer: The Phase III Randomized ESOGIA-GFPC-GECP 08-02 Study
Abstract
Purpose: Comprehensive geriatric assessment (CGA) is recommended to assess the vulnerability of elderly patients, but its integration in cancer treatment decision making has never been prospectively evaluated. Here, in elderly patients with advanced non–small-cell lung cancer (NSCLC), we compared a standard strategy of chemotherapy allocation on the basis of performance status (PS) and age with an experimental strategy on the basis of CGA. Patients and Methods: In a multicenter, open-label, phase III trial, elderly patients ≥ 70 years old with a PS of 0 to 2 and stage IV NSCLC were randomly assigned between chemotherapy allocation on the basis of PS and age (standard arm: carboplatin-based doublet if PS ≤ 1 and age ≤ 75 years; docetaxel if PS = 2 or age > 75 years) and treatment allocation on the basis of CGA (CGA arm: carboplatin-based doublet for fit patients, docetaxel for vulnerable patients, and best supportive care for frail patients). The primary end point was treatment failure free survival (TFFS). Secondary end points were overall survival (OS), progression-free survival, tolerability, and quality of life. Results: Four hundred ninety-four patients were randomly assigned (standard arm, n = 251; CGA arm, n = 243). Median age was 77 years. In the standard and CGA arms, 35.1% and 45.7% of patients received a carboplatin-based doublet, 64.9% and 31.3% received docetaxel, and 0% and 23.0% received best supportive care, respectively. In the standard and CGA arms, median TFFS times were 3.2 and 3.1 months, respectively (hazard ratio, 0.91; 95% CI, 0.76 to 1.1), and median OS times were 6.4 and 6.1 months, respectively (hazard ratio, 0.92; 95% CI, 0.79 to 1.1). Patients in the CGA arm, compared with standard arm patients, experienced significantly less all grade toxicity (85.6% v 93.4%, respectively P = .015) and fewer treatment failures as a result of toxicity (4.8% v 11.8%, respectively; P = .007). Conclusion: In elderly patients with advanced NSCLC, treatment allocation on the basis of CGA failed to improve the TFFS or OS but slightly reduced treatment toxicity.
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Geriatric assessment-based models exist for predicting chemotherapy toxicity and can support treatment choices in older adults.
“Models based on GA have been developed to predict chemotherapy toxicity and may aid therapeutic decisions in older patients.”
The DAFI-CGA provides a summary measure of vulnerability in older cancer patients.
“the frailty index determined from a CGA provides a summary measure which could prove useful to oncologists who are increasingly seeking to use the concept of frailty to direct treatment decisions (20).”
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 [20]
A recent phase III trial did not show that allocating chemotherapy by comprehensive geriatric assessment improves survival in elderly patients with advanced NSCLC.
“a recently published phase III trial did not demonstrate an improvement in survival outcomes of elderly patients with advanced NSCLC deriving from CGA-based allocation of chemotherapy [76].”
From Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2016) · cites this paper as [76]
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- Authors
- Corre, R., Greillier, L., Le Caër, H., Audigier-Valette, C., Baize, N., Bérard, H., Falchero, L., Monnet, I., Dansin, E., Vergnenègre, A., Marcq, M., Decroisette, C., Auliac, J.-B., Bota, S., Lamy, R., Massuti, B., Dujon, C., Pérol, M., Daurès, J.-P., Descourt, R., Léna, H., Plassot, C., & Chouaïd, C.
- Affiliations
- Centre Hospitalier Universitaire d'Angers (FR)
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos...
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2016-05-01
- Volume
- 34
- Issue
- 13
- Pages
- 1476-1483
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2281930375
- Cited by
- 403
- References
- 32
- Citations by year
- 2026: 18 · 2025: 11 · 2024: 37 · 2023: 35 · 2022: 47 · 2021: 40 · 2020: 50 · 2019: 40 · 2018: 56 · 2017: 43 · 2016: 23 · 2015: 1
- FWCI
- 31.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Funders
- American Society of Clinical Oncology
- Centre Hospitalier Universitaire de Rennes
- National Cancer Institute
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
- Keywords
- comprehensive geriatric assessment, advanced non-small cell lung cancer, elderly patients, frailty, performance status, docetaxel, treatment toxicity, overall survival, best supportive care, geriatric oncology, treatment decision-making, quality of life, treatment tolerability
- MeSH terms
- Pemetrexed, Docetaxel, Gemcitabine, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Non-Small-Cell Lung, Carcinoma, Squamous Cell, Deoxycytidine, Female, Follow-Up Studies, Humans, Lung Neoplasms, Male, Neoplasm Staging, Prognosis, Quality of Life, Geriatric Assessment, Survival Rate, Carboplatin, Paclitaxel, Taxoids
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