April 2019

Below are key updates in Geriatric oncology from the last 5 weeks, curated by Dr. Lorenzo Dottorini.

1. Using Implementation Science to Promote the Use of the G8 Screening Tool in Geriatric Oncology Pauline Gulasingam MBBS et al Journal of American Geriatrics Society doi.org/10.1111/jgs.15920

The use of the G8 tool as a geriatric screening evaluation is generally sub-optimal. What are the barriers and limitations for its use and what are the possible implementations strategies to improve its use? The authors discuss this. 

2. Benefit of immunotherapy (IT) in advanced non-small cell lung cancer (NSCLC) in elderly patients (EP)’ Elena Corral de la Fuente et al. Annals of Oncology, Volume 30, 20019 Supplement 2. doi:10.1093/annonc/mdz072

The abstract presented at ELCC 2019 regarding the use of immunotherapy in elderly people affected by NSCLC. This is a single-centre,  retrospective analysis of 98 elderly patients affected by NSCLC and treated with immunotherapy. In their analysis overall survival of elderly patients is significantly lower than younger patients. No significant differences in toxicity were observed.  

3.  Safety and efficacy of pembrolizumab (Pembro) monotherapy in elderly patients with PD-L1-positive advanced NSCLC: Pooled analysis from KEYNOTE-010, -024 and -042’ Kaname Nosaki et al. Annals of Oncology, Volume 30, 20019 Supplement 2. doi:10.1093/annonc/mdz072.

Another abstract presented at ELCC 2019 regarding the use of immunotherapy in elderly people affected by NSCLC. The authors made a pooled analysis of three randomised trial regarding the use of Pembrolizumab Vs chemotherapy (Keynote 010, Keynote 042, Keynote 024) focusing on elderly patients. Their results results show significantly improved overall survival in elderly patients with PD-L1 tumors scores ≥1% treated with pembrolizumab compared to those treated with chemotherapy (hazard ratio 0.76, 95% confidence interval 0.56-1.02). The improvement in overall survival with pembrolizumab compared to chemotherapy was even greater in patients with PD-L1 tumor scores ≥50% (HR 0.41, 95% CI 0.23-0.73). One-year overall survival rates with pembrolizumab in elderly patients were comparable to those in younger patients (53.7% vs 54.9% in PD-L1 TPS ≥1% and 61.7% vs 61.7% in PD-L1 TPS ≥50%).

4. Extremity soft tissue sarcoma in the elderly: Are we overtreating or undertreating this potentially vulnerable patient population? Gingrich AA et al. J Surg Oncol. 2019 Apr 12. doi: 10.1002/jso.25470.

A paper that analyzes the differences of surgical treatment and outcome in elderly patients affected by Soft Tissue Sarcoma. Again, it is underlined that elderly patients represent a distinct cohort for whom more careful selection appears indicated.

5. Integrating geriatric assessment into routine gastrointestinal (GI) consultation: The Cancer and Aging Resilience Evaluation (CARE) Grant R. Williams et al. Journal of Geriatric Oncology April 2019 doi.org/10.1016/j.jgo.2019.04.008

Patients with gastrointestinal malignancies were asked to complete the Cancer and Aging Resilience Evaluation (CARE) on their first visit , a geriatric assessment (GA) adapted from the Cancer and Aging Research Group with modifications to create a completely patient-reported version of the GA. Due to the difficulties to make a full geriatric assessment in everyday clinical practice this could represent a great step toward the introduction of systematic geriatric assessment.  

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