1050PD - The ELAN-ONCOVAL (ELderly heAd and Neck cancer-Oncology eValuation) study: Evaluation of the feasibility of a suited geriatric assessment for use b...

Date 09 September 2017
Event ESMO 2017 Congress
Session Head and neck cancer, excluding thyroid
Topics Cancer in Adolescents
Geriatric Oncology
Cancer in Special Situations
Head and Neck Cancers
Presenter Cecile Mertens
Citation Annals of Oncology (2017) 28 (suppl_5): v372-v394. 10.1093/annonc/mdx374
Authors C. Mertens1, H. Le Caer2, C. Ortholan3, E. Blot4, C. Even5, H. Rousselot6, F. Peyrade7, C. Sire8, D. Cupissol9, Y. Pointreau10, P. Debourdeau11, F. Rolland12, J. Fayette13, O. Capitain14, X. Sun15, M. Debbah5, D. Schwob16, R. Boulahssass17, A. Aupérin5, J. Guigay18
  • 1Oncology, Institut Bergonié, 33000 - Bordeaux/FR
  • 2Oncology, Hospital, Saint Brieuc/FR
  • 3Radiotherapy, Princess Grace Hospital, Monaco/MC
  • 4Oncology, Centre d'Oncologie St. Yves, 56000 - Vannes/FR
  • 5Oncology Medical, Institut Gustave Roussy, 94800 - Villejuif/FR
  • 6Gerontology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy/FR
  • 7Onco-hematology, Centre Antoine Lacassagne, 06100 - Nice/FR
  • 8Radiotherapy, Hôpital Bretagne Sud, Lorient/FR
  • 9Oncology, Institut régional du Cancer de Montpellier, Montpellier/FR
  • 10Oncology, Centre Jean Bernard et Clinique Victor Hugo, Le Mans/FR
  • 11Oncology, Institut Sainte Catherine, Avignon/FR
  • 12Oncology, Centre de Cancérologie René Gauducheau, Saint-Herblain/FR
  • 13Medical Oncology, Centre Léon Bérard, Lyon/FR
  • 14Oncology, Centre Paul Papin, 49100 - Angers/FR
  • 15Radiothérapy, Hopital du nord franche comté ( HNFC) & CHRU Besançon, 25209 - Montbéliard & Besançon/FR
  • 16Oncology Research, Gustave Roussy, Villejuif/FR
  • 17Gerontology, CHU de Nice, Nice/FR
  • 18Department Of Medical Oncology, Centre Antoine Lacassagne, Nice/FR

Abstract

Background

About 47% and 10% of head and neck squamous cell carcinomas (HNSCC) occur in patients (pts) aged 65+ or 80+ respectively. This population being heterogeneous, balancing efficacy with toxicity is challenging.

Methods

ONCOVAL is the first step of the ELAN program for pts 70+ with HNSCC, not amenable to surgery. During ONCOVAL, pts were assessed for frailty before inclusion to appropriate trial depending on curative or palliative setting and fit or unfit status. The primary aim was to evaluate whether a suited geriatric evaluation (SGE) for use by oncologist is feasible to stratify pts as fit or unfit. The SGE was elaborated by GERICO (French UNICANCER group dedicated to clinical research in elderly cancer pts) specifically for HNSCC pts, derived from the comprehensive geriatric assessment (CGA) and evaluating functional status, comorbidity, cognition, mental health status, social status, nutrition. Full CGA performed by geriatricians was optional.

Results

Between 06/2013 and 02/2017, 495 pts were included in 42 centers. Data available for 463 pts. Median age 79 years (70-95) with 46% over 80. 74% males. 67% of SGE was performed by oncologists and 33% by nurses/clinical research staff. Mean time to complete SGE was 22 minutes. After SGE, 72% pts were classified as unfit. 52% of pts were further assessed by CGA, 48% among SGE fit pts and 53% among SGE unfit pts. Concordance rate of classification Unfit/Fit by SGE and CGA was 81%. Among pts planned to be treated by curative radiotherapy (RT) or chemo(CT)-RT after oncologic evaluation alone, the planned treatment changed after SGE for 8% of pts: addition of CT/biotherapy to RT for 4% or deletion of CT for 4%. Rate of pts requiring multidisciplinary interventions was significantly higher when the assessment was also performed by geriatricians (71% vs 51%), even after adjusting for frailty.

Conclusions

A CGA-based SGE for use by oncologist in older pts with HNSCC seems feasible and is a first necessary step to define optimal care. Oncologists and geriatricians must keep going developing such close collaboration and data sharing before proposing tailored treatment.

Clinical trial identification

Legal entity responsible for the study

Gustave Roussy

Funding

INCa (National Institut of Cancer), ARC, Ligue Nationale Contre le Cancer

Disclosure

H. Le Caer: Grant/: research: Roche. C. Even: Advisory/Board Member: Bristol-Myers Squibb, AstraZeneca, Merck Serrono, MSD, Innate Pharma. F. Peyrade: Advisory board: Board ORL Merck France. Y. Pointreau: Advisory/Board Member: Bristol-Myers Squibb; Honoraria: Bristol-Myers Squibb, MSD. P. Debourdeau: Advisory/Board Member: Pfizer. J. Fayette: Advisory/Board Member: Bristol-Myers Squibb, Honoraria: Bristol-Myers Squibb, AstraZeneca. R. Boulahssass: Advisory/Board Member: Teva Honoraria: Nutricia, Roche, Teva, Novartis, Pierre Fabre, Amgen, takeda, Kephren. J. Guigay: Advisory board: AstraZeneca; Bristol-Myers Squib, Innate Pharma, Merck serono Grant/: research: Bristol-Myers Squibb, Chugai, Gsk, Merck Serono. All other authors have declared no conflicts of interest.