Patients aged 70 or older (≥ 70) with advanced oesophagogastric cancer (OGC) experience similar benefits from palliative chemotherapy compared to younger patients.
Authors: Trumper, M.J., Norman, A.R., Ross, P.J., Cunningham, D., Hawkins, R., Seymour, M., Harper, P., Iveson, T., Nicholson, M. and Hickish, T.
Journal: J Clin Oncol
Volume: 22
Issue: 14_suppl
Pages: 4018
eISSN: 1527-7755
Abstract:4018 Background: The benefits of chemotherapy for advanced OGC are well established, although there are few data specifically examining such treatment in the elderly. METHODS: Between 1992 and 2001, 1080 patients were enrolled into 3 randomised trials of chemotherapy; 702 received a cisplatin-containing regimen, 126 FAMTX and 252 5-fluorouracil +/- mitomycin C (5-FU +/- MMC). Treatment was for 24 weeks with CT scan assessment at 12 and 24 weeks. This analysis compares the outcome between patients aged ≥ 70 years with those <70 years. RESULTS: 257 patients were ≥ 70. Baseline characteristics were well balanced except there were more patients <70 with metastatic disease (76.5% v 62.4% p<0.001). There were no significant differences in grades 3/4 haematological and non-haematological toxicities. After adjusting for chemotherapy regimens no significant differences were identified in response rates between the age groups and were 43% v 44% with platinum-containing regimens (p=0.9), 6% v 21% with FAMTX (p=0.3) and 17% v 18% in the 5-FU +/- MMC group. Symptom improvement rates for dysphagia, reflux, pain, anorexia, nausea and vomiting were not significantly different between the age groups and ranged from 59-80%. 1-year survival in patients ≥ 70 and < 70 with cisplatin-containing regimens was 35.3% v 35.2%, 6.7% v 23.4% with FAMTX and 20.8% v 20 % with 5-FU +/- MMC. On multivariate analysis controlling for PS, locally advanced disease and treatment, there was no significant difference in overall survival (p=0.46) and failure free survival (p=0.94) by age. CONCLUSION: Patients ≥ 70 years with OGC obtain the same benefit from palliative chemotherapy with respect to symptomatic response, tumour regression and survival, without increased toxicities. No significant financial relationships to disclose.
Source: PubMed