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Rôle de l’évaluation gériatrique dans le traitement des CBNPC au stade métastatique

The role of geriatric assessment in the treatment of metastatic NSCLC

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Oncologie

Abstract

The incidence of lung cancer in the elderly is increasing. In stage IV, amono-chemotherapy has been for a long time the standard of treatment. Recent data have demonstrated the superiority of a carboplatin-based bitherapy versus a monotherapy in terms of overall survival. However, this bitherapy remains dedicated to fit elderly patients. Unfortunately, in clinical trials, bitherapy selection criteria are usually not precise enough, which is a limitation for the application of the results in clinical practise. The use of a geriatric assessment is recommended in order to detect the vulnerability and the tolerance of treatments. The real impact of these geriatric tools is evaluated by prospective studies. They will also possibly help us to better define the more useful tools in the specific context of lung cancer and its treatments.

Résumé

L’incidence du cancer bronchique augmente chez les sujets âgés. Dans les stades IV, une mono-chimiothérapie a long-temps été le standard de traitement. Des données récentes ont démontré la supériorité en survie globale d’une bithérapie à base de carboplatine sur une monothérapie. Mais cette bithérapie reste destinée aux sujets âgés indépendants. Malheureusement, les critères oncogériatriques de sélection des patients dans les études demeurent insuffisamment précis ce qui limite leur application dans la pratique clinique. La réalisation d’une évaluation gériatrique est actuellement recommandée afin de détecter la vulnérabilité et la tolérance aux traitements. L’impact réel de l’utilisation de ces outils est en cours d’évaluation à travers des études prospectives qui par ailleurs permettront peut être de définir les outils les plus pertinents dans le contexte spécifique du cancer bronchique et de ses traitements.

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Références

  1. Aaldriks AA, Maartense E, Le Cessie S, et al. (2011) Predictice value of geriatric assessment for patients older than 70 years, treated with chemotherpy. Crit Rev Oncol Hematol 79(2): 205–212. Epub 2010 Aug 14

    Article  PubMed  CAS  Google Scholar 

  2. Abe T, Yokoyama A, Takeda K, et al. (2011) Randomized phase III trial comparing weekly docetaxel (D)-cisplatin (P) combination with triweekly D alone in elderly patients (pts) with advanced non-small cell lung cancer (NSCLC): an inter-group trial of JCOG0803/WJOG4307L. J Clin Oncol 29(Suppl; abstr 7509)

  3. Asmis TR, Ding K, Seymour L, et al. (2008) Age and comorbidity as independent prognostic factors in the treatment of non-small cell lung cancer: a review of National Cancer Institute of Canada Clinical Trials Group Trials. J Clin Oncol 26: 54–59

    Article  PubMed  CAS  Google Scholar 

  4. Balducci L, Extermann M (2000) Management of cancer in the older person: a practical approach. The Oncologist 5(3): 224–237

    Article  PubMed  CAS  Google Scholar 

  5. Caillet P, Canoui-Poitrine F, Vouriot J, et al. (2011) Comprehensive geriatric assessment in the decision-making process in elderly patient with cancer: ELCAPA Study. J Clin Oncol 29(27): 3636–3642. Epub 2011 Jun 27.

    Article  PubMed  Google Scholar 

  6. Colinet B, Jacot W, Bertrand D, et al. (2005) A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the charlson’s index. Br J Cancer 93: 1098–1105

    Article  PubMed  CAS  Google Scholar 

  7. Corre R, Chouaid C, Barlesi F, et al. (2011) Phase III, randomized, multicenter trial involving subjects over age 70 with stage IV non-small cell lung cancer and comparing a “classical” strategy of treatment allocation (dual-agent therapy based on carboplatin or monotherapy with docetaxel alone), based on performance status and age, with an “optimized” strategy allocating the same treatments according to a simplified geriatric screening scale, plus a more thorough geriatric evaluation if necessary. J Clin Oncol 29: (Suppl; abstr TPS219)

  8. Dujon C, Azarian R, Azarian V, Petitpretz P (2006) Lung cancer in the elderly: performance status and/or geriatric indices ? Rev Mal Respir 23(4 Pt 1): 307–318

    Article  PubMed  CAS  Google Scholar 

  9. Elderly Lung Cancer Vinorelbine Italian Study Group (1999) Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small cell lung cancer. J Natl Cancer Inst 91: 66–72

    Article  Google Scholar 

  10. Extermann M (1998) Comorbidity and functionnal status are independant in older cancer patients. J Clin Oncol 16(4): 1582–1587

    PubMed  CAS  Google Scholar 

  11. Extermann M (2003) Studies of comprehensive geriatric assessment in patients with cancer. Cancer Control 10: 463–468

    PubMed  Google Scholar 

  12. Extermann M, Hurria A (2007) Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol 25(14): 1824–1831

    Article  PubMed  Google Scholar 

  13. Extermann M, Zanetta S, Chen H (2001) Are older french patients as willing as older American patients to undertake chemotherapy Proc. Am Soc Clin Oncol 403: 1603

    Google Scholar 

  14. Firat S, Byhardt RW, Gore E (2002) Comorbidity and karnofski performance score are independent prognostic factors in stage III non-small-cell lung cancer: an institutional analysis of pateints treated on four RTOG studies. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 54: 357–364

    Article  PubMed  Google Scholar 

  15. Frasci G, Lorusso V, Panza N, et al. (2001) Gemcitabine plus vinorelbine yields better survival outcome than vinorelbine alone in elderly patients with advanced non-small-cell lung cancer 34: S65–S69

    Google Scholar 

  16. Girones R, Torregrosa D, Gomez-Codina J, et al. (2011) Prognostic impact of comorbidity in elderly lung cancer patients: use and comparison of two scores. Lung Cancer 72(1): 108–113

    Article  PubMed  Google Scholar 

  17. Gosney MA (2005) Clinical assessment of eldermly people with cancer. Lancet Oncol 6: 790–797

    Article  PubMed  Google Scholar 

  18. Gridelli C, Perrone F, Gallo C, et al. (2003) Chemotherapy for elderly patients with advanced non-small-cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. J Natl Cancer Inst 95(5): 362–372

    Article  PubMed  CAS  Google Scholar 

  19. Gridelli C, Perrone F, Monfardini S (1997) Lung cancer in the elderly. Eur J cancer 33: 2313–2314

    Article  PubMed  CAS  Google Scholar 

  20. Hurria A, Togawa K, Mohile SG, et al. (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 29(25): 3457–3465

    Article  PubMed  CAS  Google Scholar 

  21. Inoue A, Kobayashi K, Usui K, et al. (2009) North East Japan Gefitinib Study Group. First-line gefitinib for patients with advanced non-small-cell lung cancer harboring epidermal growth factor receptor mutations without indication for chemotherapy. J Clin Oncol 27(9): 1394–1400

    Article  PubMed  CAS  Google Scholar 

  22. Janssen-heijinen ML, Smulders S, Lemmens VE, et al. (2004) Effect of comorbidity on the treatment and prognosis of elderly patient with non-small cell lung cancer. Thorax 59: 602–607

    Article  Google Scholar 

  23. Kanesvaran R, Li H, Koo KN, Poon D (2011) Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patieents with cancer. J Clin Oncol 29(27): 3620–3627. Epub 2011 Aug 22

    Article  PubMed  Google Scholar 

  24. Kudoh S, Takeda K, Nakagawa K, et al. (2006) Phase III study of docetaxel compared with vinorelbine in elderly patients with advanced non-small-cell lung cancer: results of the West Japan Thoracic Oncology Group Trial (WJTOG 9904). JCO 24: 3657–3663

    Article  CAS  Google Scholar 

  25. Le Caer H, Barlesi F, Corre R, et al. (2011) A multicenter phase II randomized study of docetaxel (D)/gemcitabine (G) weekly followed by erlotinib (E) after progression versus erlotinib followed by docetaxel/gemcitabine after progression in advanced non-small cell lung cancer (NSCLC) in fit elderly patients selected with a comprehensive geriatric assessment (CGA): Groupe Français de Pneumocancerologie (GFPC)*0504. Br J Cancer 105(8): 1123–1130

    Article  Google Scholar 

  26. Le Caer H, Greillier L, Corre R, et al. (2012) A multicenter phase II randomized trial of gemcitabine followed by erlotinib at progression, versus the reverse sequence, in vulnerable elderly patients with advanced non small-cell lung cancer selected with a comprehensive geriatric assessment (the GFPC 0505 study). Lung Cancer

  27. Lee L, Cheung WY, Atkinson E, Kryzanowska MK (2011) Impact of comorbidity on chemotherapy use and outcomes in solid tumors. A systematic review. JCO 29(1): 106–111

    Article  Google Scholar 

  28. Maemondo M, Inoue A, Kobayashi K, et al. (2010) North-East Japan Study Group. Gefitinib or chemotherapy for non-samll-cell lung cancer with mutated EGFR. N Engl J Med 362(25): 2380–2388

    Article  PubMed  CAS  Google Scholar 

  29. Maione P, Perrone F, Gallo C, et al. (2005) Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 23(28): 6865–6872

    Article  PubMed  Google Scholar 

  30. Mok TS, Wu YL, Thongprasert S, et al. (2009) Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 361(10): 947–957

    Article  PubMed  CAS  Google Scholar 

  31. Pallis AG, Gridelli C, van Meerbeeck JP, et al. (2010) EORTC Elderly Task Force and Lung Cancer Group and International Society for Geriatric Oncology(SIOG) experts’opinion for the treatment of non-small-cell lung cancer in an elderly population. Ann Oncol 21: 692–706

    Article  PubMed  CAS  Google Scholar 

  32. Quoix E, Monnet I, Scheid P et al. (2010) Management and outcome of french elderly patients with lung cancer: an IFCT survey. Rev Mal Respire 27: 421–430

    Article  CAS  Google Scholar 

  33. Quoix EA, Oster J, Westeel V, et al. (2011) Carboplatin and weekly paclitaxel doublet chemotherapy with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomized phase III trial. Lancet 378(9796): 1079–1088. Epub 2011 Aug 8

    Article  PubMed  CAS  Google Scholar 

  34. Ramalingam SS, Dahlberg SE, Langer CJ, et al. (2008) Outcomes for elderly, advanced-stage non small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: Analysis of Eastern Cooperative Oncology Group Trial 4599. J Clin Oncol 26(1): 60–65

    Article  PubMed  CAS  Google Scholar 

  35. Read WL, Tierney RM, Page NC et al. (2004) Differential prognostic impact of comorbidity. J Clin Oncol 22: 3099–3103

    Article  PubMed  Google Scholar 

  36. Reck M, von Pawel J, Zatloukal P, et al. (2009) Phase III trial of cisplatin plus gemcitabine with either placebo or bevacizumab as first-line therapy for nonsquamous non-small-cell lung cancer:AVAIL. J Clin Oncol 27(8): 1227–1234. Epub 2009 Feb 2

    Article  PubMed  CAS  Google Scholar 

  37. Repetto L, Fratino L, Audisio RA, et al. (2002) Comprehensive geriatric assessment adds information to Eastern Cooperative Oncolgy Group performance status in elderly cancer patients: an italian Group for Geriatric Oncology Study. J Clin Oncol 20: 494–502

    Article  PubMed  Google Scholar 

  38. Repetto L, Venturino A, Fratino L, et al. (2003) Geriatric oncology: a clinical approach to the older patient with cancer. Eur J Cancer 39(7): 870–880. Review

    Article  PubMed  CAS  Google Scholar 

  39. Rosell R, Moran T, Queralt C, et al. (2009) Screening for epidermal growth factor receptor mutations in lung cancer. N Engl J Med 361(10): 958–967

    Article  PubMed  CAS  Google Scholar 

  40. Soubeyrand P, Bellera C, Goyard J, et al. (2011) Validation of the G8 screening tool in geriatric oncology: the oncodage project. Abs 9001. ASCO 2011

  41. Stuck AE, Siu AL, Wieland GD, et al. (1993) Comprehensive geriatric assesment: a meta-analysis of controlled trials. Lancet 342: 1032–1036

    Article  PubMed  CAS  Google Scholar 

  42. Wheatley-Price P, Ding K, Seymour L, et al. (2008) Erlotinib for advanced non-small-cell lung cancer in the elderly: an analysis of the National Cancer Institute of Canada Clinical Trials Group Study BR.21. J Clin Oncol 26(14): 2350–2357

    Article  PubMed  CAS  Google Scholar 

  43. Wozniak AJ, Garst J, Jahanzeb M, et al. (2010) Clinical outcomes (CO) for special populations of patients (pts) with advanced non-small cell lung cancer (NSCLC): results from ARIES, a bevacizumab (BV) observational cohort study (OCS). J Clin Oncol 28: 15s (Suppl; abstr 7618)

    Google Scholar 

  44. Zhou C, Wu YL, Chen G, et al. (2011) Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study. Lancet Oncol 12(8): 735–734

    Article  PubMed  CAS  Google Scholar 

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  1. Service de pneumologie, hôpital Pontchaillou, CHU de Rennes, Rennes, France

    R. Corre

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Corre, R. Rôle de l’évaluation gériatrique dans le traitement des CBNPC au stade métastatique. Oncologie 14, 289–296 (2012). https://doi.org/10.1007/s10269-012-2155-8

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  • DOI: https://doi.org/10.1007/s10269-012-2155-8

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