Abstract 1249P
Background
Standard treatment for patients with resectable gastric, gastro-oesophageal junction and oesophageal adenocarcinoma is peri-operative chemotherapy with fluorouracil, oxaliplatin and docetaxel (FLOT). Toxicity is common, particularly fatigue, diarrhoea and neutropaenia. Older patients are perceived to be at higher risk of treatment toxicity and may not be offered standard therapy. We aimed to assess toxicity and survival outcomes for older patients (≥70 years) receiving FLOT at a tertiary centre in the UK.
Methods
Retrospective case-note review of patients receiving peri-operative FLOT from November 2017-June 2019, minimum follow-up 30 months at data cut-off.
Results
176 patients were included; 111 aged <70 and 65 aged ≥70 (range 25-81). Older patients had a higher mean number of co-morbidities (2.0 vs 1.59) with 53% vs. 41% PS 1-2 compared to younger patients. Older patients received fewer cycles of neo-adjuvant FLOT than younger patients (p=0.03) with 65% of those ≥70 years vs. 85% pts aged<70 receiving 4 cycles of neo-adjuvant FLOT. Baseline dose reductions were applied to 10/111 (9%) patients aged <70 and 12/65 (18%) patients aged ≥70. There were no statistically significant differences in the number of patients requiring a dose reduction due to toxicity (p=0.07), treatment deferral (p=0.70) hospital admission (p=0.12), experiencing ≥ grade 3 toxicity (p=0.82), receiving resection (p=0.33) or commencing adjuvant FLOT (p=0.76) between older and younger patients. Seven patients (n=2 ≥70 3%, n=5 <70 4%) died during neo-adjuvant FLOT, 2 deaths in each group were treatment related. At 30 months minimum follow-up 44% of younger patients and 46% of older patients had disease progression. Median survival was not reached for either group and no survival difference was observed (log-rank p=0.66).
Conclusions
Older patients had similar tolerance of FLOT compared to younger patients. Patients aged ≥70 years were more likely to stop neo-adjuvant FLOT early, predominantly due to treatment toxicity, but had overall similar toxicity rates and equivalent survival to younger patients and should be considered for perioperative treatment. Future research is indicated to investigate the impact of potential dose-reduced regimens.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The Christie NHS Foundation Trust.
Funding
Has not received any funding.
Disclosure
A.R. Lewis: Financial Interests, Personal, Invited Speaker: BMS, Servier. R. Lee: Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Research Grant: Bristol-Myers Squibb, Pierre Fabre. K.V. Kamposioras: Financial Interests, Personal, Invited Speaker: Servier; Financial Interests, Personal, Advisory Board: Merck. R. Hubner: Non-Financial Interests, Personal, Advisory Board: Roche, Bristol-Myers Squibb, Eisai, Celgene, Beigene, Ipsen, BTG; Financial Interests, Personal, Invited Speaker: Eisai, Ipsen, Mylan, Prime Oncology; Financial Interests, Personal, Sponsor/Funding: Bristol-Myers Squibb, Roche, Bayer. T.S. Waddell: Non-Financial Interests, Personal, Advisory Role: Roche, Pfizer, Ipsen, Bristol-Myers Squibb, Merck Sharp and Dohme, Eisai Europe; Financial Interests, Personal, Other, Travel expenses: Ipsen, Bristol-Myers Squibb, EUSA Pharma; Financial Interests, Personal, Invited Speaker: Pfizer, Ipsen, Bristol-Myers Squibb, EUSA Pharma; Financial Interests, Institutional, Funding: Bristol-Myers Squibb, Ipsen, Merck Sharp and Dohme, Pfizer, Roche, Eisai. W. Mansoor: Non-Financial Interests, Personal, Advisory Board: Ipsen, Novartis, Pfizer, Merck-Sharp Dohme, Bristol-Myers Squibb; Financial Interests, Personal, Invited Speaker: Ipsen, Novartis, Merck-Sharp Dohme; Financial Interests, Personal, Sponsor/Funding: Merck-Sharp Dohme, Ipsen; Financial Interests, Personal and Institutional, Research Grant: Nordic. All other authors have declared no conflicts of interest.