Marie Laurent1, Laurent Brureau2, Mounira El Demery3, Aude Fléchon4, Aurélie Le Thuaut5, Muriel Carvahlo-Verlinde6, Sylvie Bastuji-Garin5, Elena Paillaud7, Florence Canoui-Poitrine5, Stéphane Culine8. 1. Internal Medicine and Geriatric Department, Henri-Mondor Hospital, APHP, Créteil, France; CEpiA (Clinical Epidemiology and Aging) Unit, UPEC A-TVB DHU, IMRB,EA 7376 CEpiA University Paris Est (UPE), Créteil, France. Electronic address: marie.laurent@aphp.fr. 2. Medicine Department, Gustave Roussy Cancer Center, Villejuif, France. 3. Department of Oncology, Clinique du Cap d'Or, La Seyne sur Mer, France. 4. Department of Medical Oncology, Leon Bérard Cancer Center, Lyon, France. 5. CEpiA (Clinical Epidemiology and Aging) Unit, UPEC A-TVB DHU, IMRB,EA 7376 CEpiA University Paris Est (UPE), Créteil, France; Public Health Department, Henri-Mondor Hospital, APHP, Créteil, France; Clinical Research Unit (URC Mondor), Henri-Mondor Hospital, APHP, Créteil, France. 6. Department of Pharmacy, Henri-Mondor Hospital, APHP, Créteil, France. 7. Internal Medicine and Geriatric Department, Henri-Mondor Hospital, APHP, Créteil, France; CEpiA (Clinical Epidemiology and Aging) Unit, UPEC A-TVB DHU, IMRB,EA 7376 CEpiA University Paris Est (UPE), Créteil, France. 8. Department of Medical Oncology, Saint-Louis Hospital, AP-HP, Paris, France; University Paris Diderot, Paris, France.
Abstract
PURPOSE: Median age for the diagnosis of metastatic bladder cancer (MBC) is 73 years. The feasibility of chemotherapy in older patients is controversial. Our objectives were to assess associations linking age to first line chemotherapy regimen selection, early chemotherapy discontinuation, and 1-year mortality in everyday practice. MATERIALS AND METHODS: Between 1999 and 2011, 197 consecutive patients aged≥70 years with MBC referred to 4 hospitals were included in the AGEVIM multicenter cohort. At baseline, we recorded performance status (PS); tumor characteristics; the Charlson Comorbidity Index; and plasma creatinine, hemoglobin, and albumin. Early discontinuation data were available for 193 patients, and overall 1-year mortality for 180 patients. We assessed the probabilities of initial cisplatin-based combination chemotherapy (CCC), early discontinuation (≤2 cycles), and 1-year mortality, using multivariate logistic regression and Cox proportional hazards modeling. RESULTS: Among the 193 patients (mean age: 76±4.3y), with 2 metastatic site in median 43.5% received CCC, 36.3% gemcitabine and carboplatin, and 20.2% gemcitabine alone. The probability of CCC decreased with age independently from sex, PS, creatinine clearance, and Charlson Comorbidity Index (P<0.0001), early discontinuation occurred in 24.9% of patients. Factors independently associated with global chemotherapy early discontinuation were age (adjusted odds ratioper additional year = 1.11; 95% CI: 1.02-1.20; P = 0.01) and higher metastatic-site number (adjusted odds ratioper additional site = 1.45; 95% CI: 1.08-1.95; P = 0.01). The number of patients was too small for a robust analysis of factors associated with early chemotherapy discontinuation in each chemotherapy regiment subgroup. Independent predictors of 1-year mortality (median = 9.6 mo) were early discontinuation (adjusted hazard ratio [aHR] = 4.77 [2.85-7.96] when PS<2 and 20.6 [9.43-44.82] when PS≥2; P<0.0001), albumin<35g/l (aHR = 3.06 [1.81-5.17], P = 0.0001), creatinine clearance<30ml/min (aHR = 2.96 [1.45-6.06], P = 0.009), and higher metastatic-site number (aHR = 1.34 [1.14-1.56], P<0.0001). CONCLUSION: Less than half of older patients with MBC received initial CCC and 25% had≤2 cycles of chemotherapy. Older age was associated with decreased CCC prescription, independently from known contraindications, and with global chemotherapy early discontinuation, but not with 1-year mortality.
PURPOSE: Median age for the diagnosis of metastatic bladder cancer (MBC) is 73 years. The feasibility of chemotherapy in older patients is controversial. Our objectives were to assess associations linking age to first line chemotherapy regimen selection, early chemotherapy discontinuation, and 1-year mortality in everyday practice. MATERIALS AND METHODS: Between 1999 and 2011, 197 consecutive patients aged≥70 years with MBC referred to 4 hospitals were included in the AGEVIM multicenter cohort. At baseline, we recorded performance status (PS); tumor characteristics; the Charlson Comorbidity Index; and plasma creatinine, hemoglobin, and albumin. Early discontinuation data were available for 193 patients, and overall 1-year mortality for 180 patients. We assessed the probabilities of initial cisplatin-based combination chemotherapy (CCC), early discontinuation (≤2 cycles), and 1-year mortality, using multivariate logistic regression and Cox proportional hazards modeling. RESULTS: Among the 193 patients (mean age: 76±4.3y), with 2 metastatic site in median 43.5% received CCC, 36.3% gemcitabine and carboplatin, and 20.2% gemcitabine alone. The probability of CCC decreased with age independently from sex, PS, creatinine clearance, and Charlson Comorbidity Index (P<0.0001), early discontinuation occurred in 24.9% of patients. Factors independently associated with global chemotherapy early discontinuation were age (adjusted odds ratioper additional year = 1.11; 95% CI: 1.02-1.20; P = 0.01) and higher metastatic-site number (adjusted odds ratioper additional site = 1.45; 95% CI: 1.08-1.95; P = 0.01). The number of patients was too small for a robust analysis of factors associated with early chemotherapy discontinuation in each chemotherapy regiment subgroup. Independent predictors of 1-year mortality (median = 9.6 mo) were early discontinuation (adjusted hazard ratio [aHR] = 4.77 [2.85-7.96] when PS<2 and 20.6 [9.43-44.82] when PS≥2; P<0.0001), albumin<35g/l (aHR = 3.06 [1.81-5.17], P = 0.0001), creatinine clearance<30ml/min (aHR = 2.96 [1.45-6.06], P = 0.009), and higher metastatic-site number (aHR = 1.34 [1.14-1.56], P<0.0001). CONCLUSION: Less than half of older patients with MBC received initial CCC and 25% had≤2 cycles of chemotherapy. Older age was associated with decreased CCC prescription, independently from known contraindications, and with global chemotherapy early discontinuation, but not with 1-year mortality.
Authors: Ravi B Parikh; Eun Jeong Min; E Paul Wileyto; Fauzia Riaz; Cary P Gross; Roger B Cohen; Rebecca A Hubbard; Qi Long; Ronac Mamtani Journal: JAMA Oncol Date: 2021-12-01 Impact factor: 31.777
Authors: Ajeet Gajra; Tyler J Zemla; Aminah Jatoi; Josephine L Feliciano; Melisa L Wong; Hongbin Chen; Ronald Maggiore; Ryan P McMurray; Arti Hurria; Hyman B Muss; Harvey J Cohen; Jacqueline Lafky; Martin J Edelman; Rogerio Lilenbaum; Jennifer G Le-Rademacher Journal: J Thorac Oncol Date: 2018-03-30 Impact factor: 15.609
Authors: Gry Assam Taarnhøj; Henriette Lindberg; Line Hammer Dohn; Lise Høj Omland; Niels Henrik Hjøllund; Christoffer Johansen; Helle Pappot Journal: Health Qual Life Outcomes Date: 2020-07-11 Impact factor: 3.186