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Multicenter Study
. 2020 Oct;25(10):e1516-e1524.
doi: 10.1634/theoncologist.2019-0701. Epub 2020 Apr 30.

Predicting Chemotherapy Toxicity in Older Patients with Cancer: A Multicenter Prospective Study

Jaime Feliu  1 , Beatriz Jiménez-Munárriz  2 , Laura Basterretxea  3 , Irene Paredero  4 , Elisenda Llabrés  5 , Maite Antonio-Rebollo  6 , Beatriz Losada  7 , Enrique Espinosa  1 , Regina Gironés  8 , Ana Belén Custodio  1 , María Del Mar Muñoz  9 , Mariana Díaz-Almirón  10 , Jeniffer Gómez-Mediavilla  3 , Alvaro Pinto  1 , María-Dolores Torregrosa  4 , Gema Soler  6 , Patricia Cruz  1 , Oliver Higuera  1 , María José Molina-Garrido  9
Affiliations
Multicenter Study

Predicting Chemotherapy Toxicity in Older Patients with Cancer: A Multicenter Prospective Study

Jaime Feliu et al. Oncologist. 2020 Oct.

Abstract

Background: Standard oncology tools are inadequate to distinguish which older patients are at higher risk of developing chemotherapy-related complications.

Materials and methods: Patients over 70 years of age starting new chemotherapy regimens were prospectively included in a multicenter study. A prechemotherapy assessment that included sociodemographics, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and the development of grade 3-5 toxicity was examined by using logistic regression.

Results: A total of 551 patients were accrued. Chemotherapy doses (odds ratio [OR] 1.834; 95% confidence interval [CI] 1.237-2.719) and creatinine clearance (OR 0.989; 95% CI 0.981-0.997) were the only factors independently associated with toxicity. Only 19% of patients who received reduced doses of chemotherapy and had a creatinine clearance ≥40 mL/minute had grade 3-4 toxicity, compared with 38% of those who received standard doses or had a creatinine clearance <40 mL/minute (p < .0001). However, no satisfactory multivariate model was obtained using different selection approaches.

Conclusion: Chemotherapy doses and renal function were identified as the major risk factors for developing severe toxicity in the older patient. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up in these patients.

Implications for practice: Older patients are more vulnerable to chemotherapy toxicity. However, standard tools are inadequate to identify who is at higher risk of developing chemotherapy-related complications. Chemotherapy doses (standard vs. reduced) and renal function were identified as the major risk factors for developing severe toxicity in the elderly. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up.

Keywords: Chemotherapy; Geriatric assessment; Older patient; Toxicity; Toxicity risk score.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

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