Continuing ASCO 2015 Coverage: A SERMO Oncologist reported on the oral abstract session in geriatric oncology, Predicting and Improving Adverse Outcomes in Older Patients with Cancer.
The first abstract of the session looked at renal function as a predictor of chemotherapy-related toxicity. L.L. Peterson presented Abs 9509. The investigators estimated renal function with 4 formulas, looking for the association between renal function and serious adverse events. They also looked at chemotherapy type and direction. There were 492 patients, median age 73, from 65 to 91 years old. Serum Cr alone was a poor predictor, as were several other renal function predictors (e.g. MDRD). However, good old Cockroft-Gault estimation of CrCl, based on actual weight (not IBW) predicted toxicity. For every 10 mL/min decrease, the odds of SAEs increased 12% (p < 0.01). Results for other formulas approached but did not reach statistical significance. Dose reductions did not help reduce toxicity. Weaknesses of the study were the exclusion of extremes of BMI, few patients with CrCl < 30, and being a secondary analysis. My take: this is a simple and useful way to prognosticate risk, based on a blood test that almost everyone checks. However, it might be common sense that poor renal function predicts negative outcomes in many disease categories.
William Tse provided commentary. We have an aging population and are facing a “gerontocracy” soon. The US cancer burden of patients > 65 years old continues to increase. CrCl is a low-cost and practical measure. Perhaps the CrCl is a bystander for general physiologic fitness. Renal injury due to chemotherapy has similar mechanisms to the pathophysicology of renal aging.
Abs 9511, presented by R. Boulahssass, utilized a clinical score to predict early death at 100 days post comprehensive geriatric assessment. In this prospective study, the following predicted early death: metastatic cancer, gait speed < 0.8 m/s, low MNA score, performance status > 2, and non-breast cancer. The 100-day risk of death ranged from 5 to 60% based on the 10-point score.
Abs 9510, presented by V.J. Bray, demonstrated that a computer game (a “cognitive rehabilitation program”) possibly combats chemobrain (cognitive dysfunction) and preserves quality of life. Results were positive, but endpoints were survey-based, and not rooted in disease outcomes such as OS, PFS, or hospitalization. Nevertheless, we all have a new justification for playing video games: we’re doing cognitive rehab!
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