Abstract 399P
Background
About 50% of colorectal cancers occur in elderly patients (pts). The oncological societies suggest using geriatric tools to customize treatment. Comprehensive Geriatric Assessment (CGA) is a multidimensional assessment, classifying pts as fit, vulnerable or frail. Oncological multidimensional prognostic index (oncoMPI) is a CGA-based score which includes also tumour characteristics, classifying pts in high-, intermediate- and low-risk group. We investigated the role of CGA and oncoMPI in metastatic colorectal cancer (mCRC) elderly pts in a real-world setting.
Methods
Consecutive mCRC pts aged ≥70 years were prospectively evaluated at Istituto Oncologico Veneto from 2010 to 2020. Pts’ demographics, CGA (ECOG PS, comorbidities, medications, pain, caregiver presence, BMI, ADL and IADL, Mini Mental Status Examination, Geriatric Depression Scale), tumor characteristics (primary tumor location, RAS/BRAF status, metastases’ number), lines and regimens of chemotherapy (CT) were analysed. OncoMPI was calculated by a validated algorithm from the CGA domains. Correlation between onco-MPI and first-line decision-making was investigated by Pearson’s chi-squared test.
Results
A total of 488 mCRC pts were included, 287 males. Mean age was 76.1 years, ECOG PS was < 2 in 84%. According to CGA, 52% of pts were classified as fit, 28% vulnerable and 20% frail. According to oncoMPI score, 9%, 54% and 37% of pts were low, medium and high risk, respectively. Median overall survival (OS) was 22.7 months. The following factors were significantly associated with OS: ECOG PS (0-1 vs > 1, HR 2.4), CGA (fit vs frail, HR 2.4), oncoMPI score (low vs high risk, HR 1.7), metastases’ number (1 vs > 1, HR 2.1), CT administration (none vs at least one line, HR 0.63), first-line regimen (monotherapy vs doublet, HR 0.7). CT administration correlated with oncoMPI scores (Pearson’s test p-value < 0.0001) providing a survival gain in all the risk subgroups.
Conclusions
CGA and oncoMPI confirmed their prognostic role in mCRC elderly pts. CGA-derived oncoMPI may help to drive decision-making in clinical practice and to standardize subgroups of the heterogenous population of elderly in clinical trials.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
F. Bergamo: Financial Interests, Personal, Invited Speaker: Lilly; Other, Other, congress: Bayer, Ipsen. S. Lonardi: Financial Interests, Personal, Advisory Board: Amgen, Merck Serono, Lilly, Servier, AstraZeneca, MSD, Incyte, Daiichi-Sankyo, Bristol-Myers Squibb; Financial Interests, Personal, Invited Speaker: Pierre-Fabre, GlaxoSmithKline; Financial Interests, Institutional, Invited Speaker: Amgen, Merck Serono, Bayer, Roche, Lilly, Astra Zeneca, Bristol-Myers Squibb. V. Zagonel: Financial Interests, Personal, Advisory Board: Bristol-Myers Squibb, MSD, Eisai, Italfarmaco; Financial Interests, Personal, Speaker’s Bureau: Roche, Astellas Pharma, Servier, AstraZeneca, Janssen, Ipsen; Financial Interests, Institutional, Research Grant: Bayer, Roche, Lilly, AstraZeneca, BMS, Ipsen, Astellas Pharma. All other authors have declared no conflicts of interest.