Description:
<jats:p> 10030 </jats:p><jats:p> Background: The decision whether to treat older patients (pts) with advanced cancer with standard (ST) or reduced therapy (RT) is complicated by heterogeneity in aging. Currently, clinical impression based largely on age and performance status, determines whether a pt is fit or unfit for ST. We evaluated the potential utility of the CTRS (Hurria JCO 2011) for treatment decision in older cancer pts. Methods: This is a prospective observational study of older pts (+65) receiving first-line chemotherapy for locally advanced or metastatic cancer for which combination chemotherapy is the standard of care. CTRS was calculated before therapy initiation assuming the pts received ST (combination therapy at the standard dose). Pts were categorized as high risk (CTRS ≥10; RT (dose reduced combination or single agent chemotherapy) deemed appropriate) or non-high risk (CTRS <10; ST deemed appropriate) for grade 3-5 adverse events (gr3-5 AEs). Treatment decision was left to the treating physician who was blinded to the CTRS result. We estimated the agreement in chemotherapy choice (ST vs RT) between treating physician and CTRS using the kappa statistic. Results: 44 pts (median 71 years) with GI (68%), GU (14%), lung (14%) or HEENT (5%) cancer were enrolled. 29 pts received ST (11 had CTRS ≥10 and 18 had CTRS <10) and 15 pts received RT (10 had CTRS ≥10 and 5 had CTRS <10). The kappa statistic showed only modest agreement in chemotherapy choice (0.26, 95%CI = -0.01 to 0.54) between physician and CTRS. Gr3-4 AEs and hospitalization due to AE occurred in 50% and 29% of 42 pts with follow-up data, respectively. There was no fatal AE. Among pts receiving ST, pts with CTRS ≥10 had a significantly higher incidence of gr3-4 AEs and hospitalization than those with CTRS <10 using Fisher's exact test (Table). In the RT group, there was no significant difference in incidence of gr3-4 AEs or hospitalization between pts with CTRS ≥10 and CTRS <10. Conclusions: Incorporation of CTRS in treatment decision may increase the proportion of elderly pts with advanced cancer who receive tolerable treatment. [Table: see text] </jats:p>