Sheima Farag1, Frits van Coevorden2, Esther Sneekes1, Dirk J Grunhagen3, Anna K L Reyners4, Pieter A Boonstra4, Winette T van der Graaf5, Hans J Gelderblom6, Neeltje Steeghs7. 1. Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. 2. Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Department of Surgical Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. 3. Erasmus MC - Cancer Institute, Department of Medical Oncology, Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. 4. University Medical Centre Groningen, Department of Medical Oncology, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. 5. The Radboud University Medical Center, Department of Medical Oncology, PO Box 9101, 6500 HB Nijmegen, The Netherlands; The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Fullham Road, London, UK. 6. Leiden University Medical Center, Department of Medical Oncology, P.O. Box 9600, 2300 RC Leiden, The Netherlands. 7. Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. Electronic address: n.steeghs@nki.nl.
Abstract
OBJECTIVE: Although gastrointestinal stromal tumours (GIST) predominantly occur in older patients, data on treatment patterns in elderly GIST patients are scarce. METHODS: Patients registered in the Dutch GIST Registry (DGR) from January 2009 until December 2016 were included. Differences in treatment patterns between elderly (≥75 years) and younger patients were compared. Multivariate analyses were conducted using logistic regression. RESULTS: Data of 145 elderly and 665 non-elderly patients were registered (median age 78 and 60 years respectively). In elderly patients, performance score (WHO-PS) and age-adjusted Charlson comorbidity index (ACCI) were significantly higher (p < 0.05; p < 0.001), and albumin level significantly lower (p = 0.04). Hundred-and-nine (75.2%) elderly and 503 (75.6%) non-elderly patients had only localised disease. Surgery was performed in 57% of elderly versus 84% of non-elderly patients (p = 0.003, OR: 0.26, 95% CI: 0.11-0.63). No differences in surgery outcome or complications were found. Thirty-eight percent of elderly with an indication for adjuvant treatment did receive imatinib versus 68% of non-elderly (p = 0.04, OR: 0.47, 95% CI: 0.23-0.95). Thirty-six elderly and 162 non-elderly patients had metastatic disease. Palliative imatinib was equally given (mean dose 400 mg) and adverse events were mostly minor (p = 0.71). In elderly, drug-related toxicity was in 32.7% reason to discontinue imatinib versus 5.1% in non-elderly (p = 0.001, OR 13.5, 95% CI: 2.8-65.0). Median progression-free survival (PFS) was 24 months in elderly and 33 months in non-elderly (p = 0.10). Median overall survival (OS) was 34 months and 59 months respectively (p = 0.01). CONCLUSIONS: Elderly GIST patients with localised disease receive less surgery and adjuvant treatment, irrespective of comorbidity and performance score. Drug-related toxicity results more often in treatment discontinuation. This possibly results in poor outcome.
OBJECTIVE: Although gastrointestinal stromal tumours (GIST) predominantly occur in older patients, data on treatment patterns in elderly GIST patients are scarce. METHODS:Patients registered in the Dutch GIST Registry (DGR) from January 2009 until December 2016 were included. Differences in treatment patterns between elderly (≥75 years) and younger patients were compared. Multivariate analyses were conducted using logistic regression. RESULTS: Data of 145 elderly and 665 non-elderly patients were registered (median age 78 and 60 years respectively). In elderly patients, performance score (WHO-PS) and age-adjusted Charlson comorbidity index (ACCI) were significantly higher (p < 0.05; p < 0.001), and albumin level significantly lower (p = 0.04). Hundred-and-nine (75.2%) elderly and 503 (75.6%) non-elderly patients had only localised disease. Surgery was performed in 57% of elderly versus 84% of non-elderly patients (p = 0.003, OR: 0.26, 95% CI: 0.11-0.63). No differences in surgery outcome or complications were found. Thirty-eight percent of elderly with an indication for adjuvant treatment did receive imatinib versus 68% of non-elderly (p = 0.04, OR: 0.47, 95% CI: 0.23-0.95). Thirty-six elderly and 162 non-elderly patients had metastatic disease. Palliative imatinib was equally given (mean dose 400 mg) and adverse events were mostly minor (p = 0.71). In elderly, drug-related toxicity was in 32.7% reason to discontinue imatinib versus 5.1% in non-elderly (p = 0.001, OR 13.5, 95% CI: 2.8-65.0). Median progression-free survival (PFS) was 24 months in elderly and 33 months in non-elderly (p = 0.10). Median overall survival (OS) was 34 months and 59 months respectively (p = 0.01). CONCLUSIONS: Elderly GIST patients with localised disease receive less surgery and adjuvant treatment, irrespective of comorbidity and performance score. Drug-related toxicity results more often in treatment discontinuation. This possibly results in poor outcome.
Authors: Jip M van Elst; Nikki S IJzerman; Ron H J Mathijssen; Neeltje Steeghs; Anna K L Reyners; Jacco J de Haan Journal: Support Care Cancer Date: 2021-11-02 Impact factor: 3.603
Authors: Deborah van de Wal; Mai Elie; Axel Le Cesne; Elena Fumagalli; Dide den Hollander; Robin L Jones; Gloria Marquina; Neeltje Steeghs; Winette T A van der Graaf; Olga Husson Journal: Cancers (Basel) Date: 2022-04-05 Impact factor: 6.639