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. 2024 Nov 4;29(11):e1501-e1510.
doi: 10.1093/oncolo/oyae190.

Outcomes in older adults with metastatic esophageal and gastric carcinoma treated with palliative chemotherapy

Xin Wang  1 , Michael J Allen  1 , Osvaldo Espin-Garcia  2 , Chihiro Suzuiki  1 , Yvonne Bach  1 , Elan Panov  1 , Lucy X Ma  1 , Raymond W Jang  1 , Eric X Chen  1 , Gail E Darling  3 , Jonathan Yeung  3 , Carol J Swallow  4   5 , Savtaj Singh Brar  5 , Sangeetha Kalimuthu  6 , Rebecca Wong  7 , Patrick Veit-Haibach  8 , Elena Elimova  1
Affiliations

Outcomes in older adults with metastatic esophageal and gastric carcinoma treated with palliative chemotherapy

Xin Wang et al. Oncologist. .

Abstract

Background: The incidence of esophageal and gastric carcinoma (GEC) in elderly patients is increasing, yet patients ≥75 years have historically been underrepresented in clinical trials. We sought to investigate palliative chemotherapy administration patterns and survival outcomes in older adults.

Materials and methods: A retrospective analysis identified patients aged 65-74 (young-old) and ≥75 years (older-old) diagnosed with advanced GEC. Patient and tumor characteristics were recorded, with descriptive analysis, time-to-event data analysis using Kaplan-Meier curves and multivariate Cox proportional hazards regression analysis performed.

Results: One hundred and ninety-eight "young-old" and 109 'older-old' patients were identified. Patient characteristics were similar between groups except for Charlson Co-morbidity Index (CCI), with lower co-morbidities in the "young-old" compared to "older-old" cohort (P < .001; CCI = 0 in 103 (52%) "young-old" vs 31 (28%) "older-old"). The primary diagnosis in both groups was adenocarcinoma. 119 (60%) "young-old" and 25 (23%) "older-old" patients received chemotherapy (P < .001). Performance status was the primary explanation for chemotherapy non-receipt in both cohorts; age was the explanation in 21 (25%) "older-old" patients and none in the "young-old" patients. PFS for first-line systemic therapy in "young-old" patients was 6.4 (95% CI 5.9-7.6) versus 7.5 months (95% CI 5.1-11.3) in "older-old" patients (P = .69) whilst respective OS was 12.3 (95% CI 10.1-15.5) and 10.4 months (95% CI 9.0-14.6) (P = .0816). Toxicity prompted chemotherapy cessation in 17 (15%) "young-old" and 3 (13%) "older-old" patients (P = .97). Multivariate analysis identified CCI and ECOG performance status as predictive for PFS and OS, respectively. No causative relationship was identified with other variables.

Conclusion: Our study of real-world older-adults show that significant number of "older-old" patients with GEC do not receive chemotherapy. Among "older-old" adults who do receive systemic therapy, outcomes are comparable; this underscores the importance of geriatric assessment-guided care and suggests that age alone should not be a barrier to receipt of chemotherapy in patients with advanced GEC.

Keywords: esophageal cancer; gastric cancer; geriatric oncology; palliative chemotherapy.

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Conflict of interest statement

E.E. is a consultant for BMS, Zymeworks, Adaptimmune, Beigene, Jazz, Astellas, Virecta Tx, Signatera, Abbvie, Daiichi-Sankyo, E.E. has received grant/research support from BMS, Zymeworks, Adaptimmune, Astra Zeneca, Jazz, Amgen. None relevant to this work. All other authors have no relevant disclosures.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curves for progression-free (PFS) (A) and overall survival (OS) (B) in patients receiving palliative chemotherapy (n = 144). (A) Median PFS “young-old” (65-74 years) 6.4m (95% CI 5.9-7.6), median PFS “older-old” (≥ 75 years) 7.5m (95% CI 5.1-11.3) (P = .69). (B) Median OS “young-old” 12.3m (95% CI 10.1-15.5), median OS “older-old” 10.4m (95% CI 9.0-14.6) (P = .082).
Figure 2.
Figure 2.
Overall survival (OS) Kaplan-Meier curve for total population (n = 307) median OS “young-old” (65-74 years) 8.1m (95% CI 6.6-10.1), median OS “older-old” (≥ 75 years) 5.3m (95% CI 4.4-7.7; P = 2.93e−05 log rank).
See this image and copyright information in PMC

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