Abstract 1701P
Background
The Cancer and Aging Research Group (CARG) toxicity score is a validated tool to predict chemotherapy toxicity for older adults with cancer. However, little is known regarding the impact of the CARG-score on survival outcomes.
Methods
This prospective study evaluated survival and toxicity outcomes according to a 2 x 2 table by CARG-score categories: non-high risk (score <10) vs. high risk (≥10) and treatment intensity: standard-intensity therapy (ST) vs. reduced-intensity therapy (RT). Patients were aged ≥65 years receiving first-line chemotherapy for advanced non-colorectal GI cancer for which combination chemotherapy is the standard of care. Treatment decision was made by the treating oncologist, who was blinded to the CARG-scores. We estimated overall survival (OS) and time to treatment failure (TTF), defined as the time from the start to discontinuation of first-line chemotherapy for any reason.
Results
Fifty patients (median age, 71 years) enrolled and 76% had Karnofsky performance status (KPS) ≥80. Cancer types were pancreatic (60%), upper GI tract (28%) and biliary tract (12%). For 28 non-high-risk patients, median OS and TTF of patients treated with ST and RT was 19.7 months vs. 12.7 months (hazard ratio (HR), 0.65; 95% CI: 0.27-1.56) and 9.1 months vs 2.5 months (HR, 0.49; 95% CI: 0.19-1.31; P = 0.16), respectively. Incidence of grade 3-5 adverse events (AEs) was 68% in ST group and 33% in RT group. Among 22 high risk patients, median OS and TTF of patients treated with ST and RT was 4.5 months vs. 3.9 months (HR, 1.25; 95% CI: 0.51-3.06; P = 0.62) and 2.3 months vs 3.0 months (HR, 1.66; 95% CI: 0.66-4.19; P = 0.28), respectively. Grade 3-5 AEs occurred in 92% of ST group and 70% of RT group. Additionally, CARG-score category was prognostic of OS and TTF (Table). Table: 1701P
Prognostic factors for OS and TTF by univariable analysis
| Variables | HR (95% CI) | P value |
| OS | ||
| CARG-score; High-risk vs Non-high risk | 3.04 (1.59-5.83) | 0.001 |
| KPS; <80 vs ≥80 | 1.52 (0.78-2.98) | 0.22 |
| Treatment Intensity; ST vs RT | 0.76 (0.41-1.39) | 0.37 |
| TTF | ||
| CARG-score; High-risk vs Non-high risk | 2.60 (1.31-5.20) | 0.007 |
| KPS; <80 vs ≥80 | 0.87 (0.43-1.73) | 0.68 |
| Treatment Intensity; ST vs RT | 0.76 (0.41-1.43) | 0.40 |
Conclusions
This study suggests that risk-adapted chemotherapy based on the CARG-score may result in better treatment outcomes for older adults with advanced non-colorectal GI cancers.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
University Cancer Research Fund of the State of North Carolina.
Disclosure
All authors have declared no conflicts of interest.