CN20 - Oral targeted therapy dose adaptation in geriatric cancer patients: A real life French cohort

Background

Oral targeted therapies (OTT) are widely used to treat many cancers. However, there is no recommendation about OTT dose adaptation in the growing oncogeriatric population. Objective: To analyze in a real-life cohort the baseline prescribed dose of OTT in older cancer patients, and the reasons for dose modifications.

Methods

This non-interventional, retrospective study included patients ≥70 years old treated in our comprehensive cancer center between 02/2016 and 08/2019 for a metastatic cancer with one of our 6 most prescribed OTT. Oral chemotherapy agents were excluded. Data were extracted from patient medical record: age, type of OTT, initial dose, oncogeriatric evaluation, treatment duration and toxicity based on CTCAE version 5.0.

Results

123 of 986 patients treat with OTT in our cohort were ≥ 70 years old and received one of the 6 selected OTT (Afatinib 15.4%, Everolimus 14.6%, Palbociclib 51.2%, Pazopanib 9.8%, Sorafénib 5.7% and Sunitinib 3.2%). At baseline, the prescribed dose of OTT was lower than the recommended dose in 28 % of cases (35/123). Patients with baseline dose reduction were significantly older (mean age 80 years vs 74 years, p <0.001), and more frequently affected by a PS >0 (70%) compared to the standard dose group (55%), p < 0.01. However, only 8 patients had a formal oncogeriatric evaluation, 4 in standard dose group (4.5%) and 4 in baseline dose reduction group (11%). p=0.22. Higher toxicities grades were statistically more frequently reported in the recommended dose group (p= 0.035) leading to more subsequent dose reduction in this subgroup (40% of patients (35/88)) compared to the adapted dose cohort (20% of patients (7/35), p=0.037. At the end of study, 51% of patients of our entire cohort (63/123) received a lower dose than the recommended one.

Conclusions

Initial OTT dose adaptation appears frequent in our elderly cancer population (28%), however rarely based on a formal oncogeriatric evaluation (6.5%). In the absence of recommendation, clinical studies are necessary to evaluate the efficacy and safety of OTT dose reduction in this elderly population.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.