17th - 19th Nov 2016
Prof Aapro speaks with ecancertv at SIOG 2016 about clinical research in geriatric oncology, and his perspective as a supportive care specialist.
This service has been kindly supported by an unrestricted grant from Merck/MSD.
Clinical research in geriatric oncology faces quite a few challenges. If we just look at the general picture there is a paucity of real elderly patients introduced into clinical studies because clinical studies have limitations not related to age, except in a few studies, but related to the potential different comorbidities that patients have. We know that the older the patient is the higher the risk of comorbidities, nevertheless when we see these patients in practice we have to deal with them. From the perspective of supportive care it is clear from many studies that the elderly patients have lesser physiological reserves in order to tolerate the impact to be not too negative of the treatment on their general health. We need to be more proactive and this has been shown to be true with the use of growth factors like GCSF where from all guidelines it is indicated that after age 65 you should consider the use if you have any doubts about the risk of febrile neutropenia.
It is not only that, we have many other side effects that these treatments, whichever they are, including immunotherapy, can give to patients and from the perspective of the supportive care person we really have to develop those studies to show that we can help these patients. For the time being we have not concentrated on this but we know that some of the side effects that patients can face when they’re younger they’re already extremely annoying, just take the example of diarrhoea. Younger patients will be very much annoyed by the very prominent diarrhoea that can be related either to chemotherapy or to some immunotherapies. An older person that has problems in moving around will have even worse problems. Many elderly people don’t want to say that but they have also some continence issues so this can become a drama for the patient. Some of these treatments are extremely effective and we really need to find ways to help these patients so that they can get the benefit without too many side effects. So it’s a conjunction of the elderly having less reserves and us being able to provide the appropriate treatment early enough in order to avoid the complications.
What is the key message for the area of supportive care?
The key message in the supportive care area for elderly patients in the research perspective is that when we are developing new interesting protocols with drugs that we already know in advance are going to have a certain type of side effect we should build into those protocols a sub-question of what is the best way to go. I’ll just give you one example: everolimus is an agent that can be combined with hormone therapy in some settings of breast cancer treatment but does induce in about 60% of patients and even a high percentage, seemingly, in some older patients, a pretty severe stomatitis for some of these patients. This was known, this was a side effect that was known but it is only after the drug was developed, after it had been registered that finally studies have been done to show that different ways of administering corticosteroids will dramatically reduce the incidence of stomatitis. So this should not be done afterwards, this should be done as the drugs are being developed.
What are the main issues that will be discussed during your sessions?
One of the issues that many people discuss is always, ‘Well, but elderly people will not accept to go into clinical trials.’ That is the same excuse that is given by many centres about even younger people saying, ‘The patient refused.’ I have never had a patient refuse to go into clinical trial once you have taken the time to explain the why. There’s a little vignette that I saw recently - a gentleman talks to his wife and says, ‘Oh, they told me about this clinical trial,’ and she says, ‘Obviously you refused, didn’t you?’ and he replies, ‘Yes, I want to wait for the results until I decide what to take.’