Comment: Chemotherapy for frail and elderly patients with advanced gastroesophageal cancer

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Published: 13 Jun 2019
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Prof Heinz-Josef Lenz - USC Norris Comprehensive Cancer Center, Los Angeles, USA

Prof Heinz-Josef Lenz talks to ecancer at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting about the GO2 phase III trial.

He describes how reducing the dosage for these patients did not have an effect on overall survival, and improves toxicity and quality of life.

There was a very interesting and unusual presentation from the UK because they looked for patients who are frail, older, not in good medical condition, not good performance status. Can we do a dose reduction without jeopardising the clinical outcome? They used that in gastroesophageal cancer. They enrolled an incredible amount of patients, over 500, and looked what the dose of the capecitabine and oxaliplatin will impact overall survival. They had the full dose, they had 80% of the dose, so 20% down, and 60% of the full dose, so 40% down, and evaluated patients based on their geriatric assessment, which has a multiple point evaluation about the functionality and symptoms so it’s very important to make sure we have an even distribution in these different arms, and monitor them for their experience under the chemo as well as clinical outcome – progression free survival and survival.

Really exciting is that the patients even in the lowest dose group, so 40% less than the original dose, did as well without outcome, progression free survival and overall survival, than the full dose group. But even more importantly their evaluation of quality of life and their toxicity profile was obviously much better, even in the higher risk groups within, it’s not only the elderly but the younger ones and fitter ones also experienced the same benefit – living as long as the full dose but had a better quality of life.

So this is a very important study which changes the way we approach the elderly or the frail patient population, that we do not have to not give any treatment, that we can give in a significant dose reduced manner with the full benefit and not only ensuring but improving their quality of life. So it was very elegant because we all see this patient population and we struggle that we don’t want to harm them with a full dose, now we have data supporting that we don’t not harm them but actually give them quality of life benefit without jeopardising clinical outcome.