Previous works in molecular portraits of cancer have shown differences by ages with the accumulation of somatic mutations, suggesting that older patients may have aged specific genomic profiles. However, there is a lack of data concerning genomic alterations in metastatic older patients. We aimed at analyzing the clinical and pathological characteristics and outcomes by genomic alterations of older patients enrolled in MOSCATO-01 trial.
We retrospectively collected data from MOSCATO-01 trial from all patients over > 70 years old enrolled from November 2011 to March 2016 and performed a descriptive analysis of this sub group of patients with advanced solid tumor.
Among the 1035 patients enrolled in the MOSCATO trial, 85 patients (8,2%) over 70 years old were included, with a median age of 74 (range 71-86). Urologic cancers were the most frequent cancer. All tumor biopsies were performed and a molecular portrait was obtained in 66 patients (77.6%). Almost 40 different molecular alterations were identified. An actionable molecular alteration was identified in 46 patients (54%). Among them, 13 patients had ≥ 2 (range 1-5) actionable targets. The most frequent alteration pathways were: Pi3K (21%), NOTCH (11,3%), FGF and FGFR mutation (both 9.7%), PTEN (6,5%), FBXW7, MDM2 and EGFR (4,8% each). A total of 23 (27%) patients were treated with a targeted therapy matched to a genomic alteration, and 15 of them were enrolled in phase 1 or 2. The PFS2/PFS1 ratio was >1.3 in 31.8 % of the patients (7/22, one missing data). Among the 46 patients with actionable molecular alteration, median overall survival was better in the group of patient with matched therapy (18.4 vs 5.4 months, p = 0,07 NS).
The genomic profile > 70 years old is feasible in advanced geriatric malignancies and can lead to a better understanding in the biology of cancer among the elderly and could improve outcomes with molecular target agents.
Clinical trial identification
MOSCATO 01 (NCT01566019).
Legal entity responsible for the study
L. Verlingue: Consultant: Adaptherapy. A. Hollebecque: Honoraria: Merck Serono; Consulting: Amgen; Expenses: Amgen, Servier. J-C. Soria: Employement and ownership: AstraZeneca; Honoraria and consulting: AstraZeneca, BMS, Pfizer, Roche, Sanofi, Pierre Fabre. C. Massard: Other relationship: Amgen, Astellas Pharma, AstraZeneca, Bayer, Celgene, Genentech, Ipsen, Novartis, Pfizer, Roche, Sanofi, Orion Corporation, Lilly Pharma, Janssen Inc. Pharmaceutical. All other authors have declared no conflicts of interest.