Abstract 1406P
Background
60% of patients with gastric and esophageal carcinoma (GEC) are aged ≥65y, with 26% >75y, yet the elderly are historically underrepresented in clinical trials. The impact of palliative chemotherapy (CTx) on survival is thus relatively poorly understood in the elderly. We sought to determine survival outcomes for patients with metastatic GEC relative to age.
Methods
A retrospective database analysis (2007-2019) was performed with patients separated by age: 65-74y (old), and ≥75y (old-old) with survival for those receiving CTx analysed. Multivariate (MVA) Cox proportional hazard regression modelling was performed with adjustment for age, gender, Charlson co-morbidity index (CCI), ethnicity, histology, location of tumour and ECOG performance status (PS).
Results
307 patients were included: 198 ‘old’ and 109 ‘old-old’. The median age was 70 v 79.5y (p<0.001). There were no significant differences relative to gender, ethnicity, BMI and PS. Median CCI for ‘old’ was 0 (0,11) and 1 (0,8) for ‘old-old’ (p<0.001). Adenocarcinoma was the most common histology in both groups. The primary tumour location was predominately esophageal/AEG1-2 in ‘old’ (62%) and gastric/AGE3 in ‘old-old’ patients (52%) (p=0.022). 119 (60%) ‘old’ and 25 (23%) ‘old-old’ patients received CTx (p<0.001). Poor PS was the most common cited rationale for non-receipt of CTx in both ‘old’ (46%) and ‘old-old’ patients (36%). Age was the second most common reason in ‘old-old’ patients (25%) but not considered prohibitive in the ‘old’ cohort (p<0.001). Disease progression lead to CTx discontinuation in 67% (old) and 70% (old-old) patients, whilst toxicity was the reason in 15% and 13% respectively (p=0.97). Median PFS was 6.4 (95% CI 5.9-7.6) v 7.5 (95% CI 5.1-11.3) months in ‘old’ and old-old’ respectively (p=0.69), whilst median OS was 12.3 (95% CI 10.1-15.5) v 10.4 (95% CI 9-14.6) months respectively (p=0.0816). MVA indicated that age did not influence PFS (p=0.94) or OS (p=0.057).
Conclusions
Whilst treatment with CTx was more common in younger patients, our analysis indicated survival outcomes were comparable with toxicity leading to treatment discontinuation rates similar. This suggests age itself should not predetermine treatment with palliative CTx.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
E. Elimova: Financial Interests, Institutional, Research Grant: BMS; Financial Interests, Institutional, Research Grant: Zymeworks; Financial Interests, Institutional, Licensing Fees, Consultancy Fees: Adaptimmune; Financial Interests, Institutional, Advisory Board: BMS; Financial Interests, Institutional, Advisory Board: Zymeworks; Financial Interests, Personal, Other, Spouse employee: Merck Vaccines. All other authors have declared no conflicts of interest.