Chemotherapy Benefit in Older Patients With Gastric Cancer Remains Unclear

03/15/17

A novel scoring system may identify elderly patients with advanced gastric cancer who may not benefit from chemotherapy.

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It remains unclear whether elderly patients with advanced gastric cancer derive benefit from chemotherapy. As such, oncologists find it difficult to select which patients should or should not be given induction chemotherapy.

Researchers in the department of gastroenterology at Toyonaka Municipal Hospital (Osakatoyonaka, Japan) conducted a retrospective study of 47 elderly patients (mean age, 81 years; 63% men) treated at their institution between April 2012 and June 2016. Of this cohort, 26 patients received chemotherapy and 21 patients received best supportive care.

Thirteen patients received S1 monotherapy; the remaining patients were treated with combination therapies. The overall cohort had a median survival time of 138 days, with no significant differences seen between patients receiving chemotherapy (median, 172 days) or best supportive care (median, 118 days).

The researchers identified five performance factors that indicated a poor prognosis for elderly patients with advanced gastric cancer: performance status of 2 (hazard ratio [HR] = 3.7; 95% CI, 1.5-8.5); C-reactive protein levels above 1 mg/dL (HR = 4; 95% CI, 1.8-9.4); albium levels greater than 3 g/dL (HR = 2.1; 95% CI, 1.1-4.3); neutrophil/lymphocyte ratio above 4 (HR = 3.7; 95% CI, 1.7-8.5); and diffuse type (HR = 1.8; 95% CI, 0.9-3.8). Coupled with age older than 80 years, these prognostic factors were used to create a scoring system to help determine whether patients were appropriate candidates for chemotherapy.

Using a scoring system of 0 to 6, the researchers determined that patients with 3 or more points should be considered at high-risk for chemotherapy failure; patients who scored between 0 and 2 were considered low-risk for failure. Based on this scoring system, 25 patients were considered high-risk and 22 patients considered low-risk.

An analysis using the scoring system found that patients in the low-risk group achieved a significantly prolonged median survival time (457 days vs 105 days). 

“When judging indication for chemotherapy in elderly patients with advanced gastric cancer, this scoring system may be useful, and in case of low-risk may be considered an indication for chemotherapy,” the researchers concluded.