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A B S T R A C T S
Thus, risk benefit in elderly pts might be questionable when
using AA which prolong survival, but might alter quality of life.
Objectives:
The aim of our study was to describe the
treatment of elderlymRCC patients withAA in routine practice
compared to a younger population in order to assess whether
age can influence treatment patterns, patients outcomes and
to identify specific toxicity profiles.
Methods:
We performed a retrospective review of all
medical records of patients treated with AA for mRCC
in 2 French institutions between June 2006 and 2015. Pts
70 y.o. were considered as elderly and pts <70 y.o. formed
the control group of young pts. Recorded variables included:
age, comorbidities, first to third-line therapies, treatment
schedules, and survival data. We assessed toxicity data by
recording toxicity-related treatment discontinuation, hemato-
logical and non-hematological grade 3-4 adverse events.
Results:
A total of 170 patients were identified, median age
was 65.2 y.o. (range 26.2-89.7). According to IMDC prognostic
model, 27.8% patients had favorable risk, 51.3% intermediate
risk and 20.9% poor risk. Both study groups were well balanced
according to IMDC risk groups. Among the whole population,
60 patients were
70 y.o.. Elderly pts were treated with
sunitinib (N=40, 66.7%), sorafenib (N=11, 18.3%) or pazopanib
(N=9, 15%). First-line median progression-free survival (PFS)
was shorter for pts
70 y.o.: 10.0 months (IC 95% [8.4-12.2])
versus 14.8 months (IC 95% [10.2-19.0]) for younger pts (p =
0.033). Median overall survival was 21.2 months (IC 95% [14.6-
46.9]) for the elderly versus 41.2 months (IC 95% [35.4-57.9]) for
younger pts (p = 0.016). In the elderly group, 35 pts received
a second-line treatment and 11 pts a third-line treatment.
The median PFS for elderly pts was 5.4 months (IC 95% [4.1-
11.4]) in second-line and 4.3 months (IC 95% [2.2-NA]) in third-
line. Grade 3-4 non-hematological toxicities were observed
in 35/60 elderly pts (58.3%), including skin toxicity (n=9),
mucositis (n=4), hypertension (n=8), fatigue (n=13), diarrhea
(n=8). No difference was found between the two groups for
grade 3-4 hypertension, skin toxicity and diarrhea. There
were significantly more grade 3-4 cardiovascular toxicities
(excluding hypertension) in the group
70 y.o. (p = 0.015).
21.6% of elderly pts definitively stopped treatment due to
toxicity versus 9.1% in younger pts (p = 0.04). Further results
on treatment schedules will be presented at the meeting.
Conclusion:
This retrospective study shows that treatment
with AA is feasible with good efficacy in elderly pts. Efficacy
observed supports the use of AA in elderly pts. However, age
appears to be a prognostic factor for patients with mRCC
treated by AA. Finally, physicians should be aware of toxicity
that seems to be more frequently limiting for elderly pts
treated with antiangiogenic therapies.
Reference
[1] Bellmunt J, Négrier S, Escudier B, Awada A, Aapro M. The
medical treatment of metastatic renal cell cancer in the
elderly: Position paper of a SIOG Taskforce. Crit Rev Oncol
Hematol. 2009 Jan;69(1):64–72.
Disclosure of interest:
L. Pierard: None declared, F.
Schaff-Wendling: None declared, A. Thiéry: None declared,
C. Korenbaum: None declared, J. Gantzer: None declared,
D. Heitz: None declared, B. Duclos Consultant for: Novartis,
Pfizer, C. Borel: None declared, J.-E. Kurtz: None declared, P.
Barthélémy Consultant for: Novartis, Pfizer
Keywords:
Antiangiogenic therapies, elderly, metastatic renal
cell carcinoma
P023
TOLERANCE AND EFFICACY OF FOLFIRINOX IN ELDERLY
PATIENTS WITH PANCREACTIC OR COLORECTAL CANCER.
A MONOCENTRIC RETROSPECTIVE STUDY ON 52 PATIENTS
J. F. Guion-Dussere
1
, A. Bertaut
2
, F. Ghiringhelli
1
, J. Vincent
1
,
V. Quipourt
3,4
, S. Marilier
3,4
, L. Bengrine Lefevre
1,4,
*
1
Medical oncology,
2
statistic department, Centre Georges François
Leclerc,
3
geriatric department, CHU Champmaillot,
4
UCOG
Bourgogne, Dijon, France
Introduction:
Chemotherapy regimen proposed in
metastatic colorectal cancer are discussed function of general
status health and cancer prognostic criteria. Data are in favor
of efficacy of Folfirinox in these pathologies for patient under
75 years old. Efficacy and tolerance are not clearly evaluated
in elderly patients.
Objectives:
The main objective of this retrospective study
was to evaluate tolerance and efficacy of Folfirinox regimen
in elderly patients diagnosed and treated for metastatic
colorectal or pancreatic cancer in the French anticancer
center Georges Francois Leclerc.
Methods:
Patients over 70 years old treated at CGFL
between January 2009 and January 2015 were included.
Histologically proved pancreatic or colorectal cancers were
required. Demographic, clinical data were recorded and
geriatric parameters as Charlson Comorbidity index (CCI) and
functional assessment. Toxicities were evaluated using the
CTCAE 4.03. Treatment continued until disease progression,
unacceptable toxicities or patient refusal. Primary endpoint
was overall survival (OS).
Results:
On the whole, 52 patients (46 men and 6 women)
were treated by Folfirinox regimen, 34 for colorectal cancer
and 18 for pancreatic cancer. Thirty seven patients had
comorbidities, 30 took 4 or more medications, 43 were 0-1
performance status, and 32 had a CCI under 10. Most of
patients had no home help at the beginning but 34 had one
at 3 months. Half of patients had at least 2 metastasis sites.
Seventy five percent had a “modified” Folfirinox at
beginning, which consist on a 5FU reduction (bolus or
continuous infusion) and irinotecan (67%) reduction. Only
26% had an adapted regimen after beginning.
Regarding adverse events, 32% (n=42) had grade 3-4
neutropenia, 9% grade 3-4 anemia, 25% grade 3-4 diarrhea.
Seven percent had grade 3-4 neuropathy and 26% of patients
had a dose adjustment after the beginning.
Twenty four patients (46%) had a stable disease or partial
response and 21% had progressive disease at 6 courses.
At progression 23 patients had a second line of treatment.
Most patients died from cancer.
In univariate analysis and in multivariate analysis, no
geriatric parameters were linked to OS (age, comorbidities,
independence, CCI, medication number or OMS status).
Primary tumor was the only factor linked to OS in univariate
and multivariate analysis.