Treatment and outcomes of elderly versus younger patients with advanced NSCLC at Mayo Clinic Arizona (MCA)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19047-e19047
Author(s):  
H. Paripati ◽  
W. Tong ◽  
N. J. Karlin ◽  
A. C. Dueck ◽  
H. J. Ross
Keyword(s):  
Elderly Patients ◽  
Median Survival ◽  
Systemic Therapy ◽  
Cox Regression ◽  
Statistical Significance ◽  
Stage Iv ◽  
The Elderly ◽  
Categorical Variables ◽  
Age Group ◽  
Metastatic Nsclc

e19047 Background: Non-small cell lung cancer (NSCLC) is predominantly a disease of the elderly. Most patients (pts) present with incurable advanced disease, but chemotherapy for good performance status (PS) pts improves quality and quantity of life. Despite good PS, many elderly pts with metastatic NSCLC do not receive chemotherapy. This study compared treatment, outcomes, and survival in elderly vs younger pts with stage IV NSCLC. Methods: All analytic MCA Cancer Registry pts with stage IV NSCLC from 1998–2007 were retrospectively reviewed for type of therapy and outcome. Pts were analyzed by age: <75 vs ≥75 years old. Categorical variables were compared using chi-squared tests and survival was compared by Cox regression. Results: 344 pts with stage IV NSCLC were identified. 234 (68%) pts were <75 years old, and 110 pts (32%) were ≥75 years old. Median survival for all pts was 7 months. Among 302 pts with treatment data available, 60.8% of pts <75 years old received some form of systemic therapy (chemotherapy/targeted therapy) compared to only 32% of pts ≥ 75 years old (p <0.0001). Among pts with PS 0–1, pts <75 years old more frequently received systemic therapy than elderly patients (88.5% vs 32.1%, p<0.0001); whereas a difference was not evident in pts with PS 2–4 (34.1% vs 41.7%, p=0.49). Median survival in the <75 age group was 7 months vs. 3.4 months in the ≥75 age group (p=0.048). In the <75 age group, median survival was 12 months in pts who received chemotherapy vs. 2 months in the other or no treatment group (p<0.0001). In the elderly group, median survival was 10 months in the chemotherapy group vs. 2 months in the pts who received other or no treatment (p=0.0003). Thus, the median survival was significantly improved among the pts who received systemic therapy independent of age. Statistical significance persisted when stratifying by PS. Conclusions: Pts with stage IV NSCLC have improved survival with systemic therapy independent of age. Our results confirm that despite an improvement in survival similar to younger pts, elderly patients with metastatic NSCLC are often undertreated. Prospective trials should be designed to include metastatic NSCLC patients without age discrimination No significant financial relationships to disclose.

scholarly journals Systemic Therapy for Elderly Patients with Gastrointestinal Cancer

2011 ◽  
Vol 5 ◽  
pp. CMO.S6983 ◽  
Author(s):  
Joleen M. Hubbard ◽  
Axel Grothey ◽  
Daniel J. Sargent
Keyword(s):  
Clinical Trials ◽  
Elderly Patients ◽  
Systemic Therapy ◽  
Survival Benefit ◽  
Older Patients ◽  
The Elderly ◽  
Age Group ◽  
Gastrointestinal Cancers ◽  
Younger Patients ◽  
Multiple Trials

The majority of patients with gastrointestinal cancers are over the age of 65. This age group comprises the minority of the patients enrolled in clinical trials, and it is unknown whether older patients achieve similar results as younger patients in terms of survival benefit and tolerability. In addition, there are few studies specifically designed for patients over 65 years. Subset analyses of individual trials and studies using pooled patient data from multiple trials provide some understanding on outcomes in older patients with gastrointestinal cancers. This article reviews the evidence on chemotherapeutic regimens in the elderly with colorectal, pancreatic, and gastroesophageal cancers, and discusses a practical approach to provide the best outcomes for older patients.

scholarly journals Treatment with CPAP in Elderly Patients with Obstructive Sleep Apnoea

2020 ◽  
Vol 9 (2) ◽  
pp. 546 ◽  
Author(s):  
Tomas Posadas ◽  
Grace Oscullo ◽  
Enrique Zaldívar ◽  
Alberto Garcia-Ortega ◽  
José Daniel Gómez-Olivas ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Elderly Patients ◽  
Obstructive Sleep Apnoea ◽  
The Elderly ◽  
Sleep Apnoea ◽  
Age Group ◽  
Obstructive Sleep ◽  
Receive Treatment ◽  
Therapeutic Tools

The population pyramid is changing as a result of the ever-increasing life expectancy, which makes it crucial to acquire an in-depth understanding of the diseases that most often affect the elderly. Obstructive sleep apnoea (OSA) affects 15%–20% of the population aged over 65 years. Despite this prevalence, there have been very few specific studies on the management of OSA in this age group, even though over 60% of the patients aged over 65-70 years who attend sleep units with suspicion of OSA receive treatment with continuous positive airway pressure (CPAP), on the basis of an extrapolation of the positive results achieved by CPAP in clinical trials involving middle-aged males. However, the latter’s form of presentation, evolution and, probably, prognosis comparing with OSA are not the same as those of elderly patients. Recent clinical trials performed on an exclusive series of elderly patients have shed light on the possible role of CPAP treatment in elderly patients with OSA, but there are still many questions that need to be answered. The physiological increase in the number of sleep-related disorders with the passing of years, and the lack of validated diagnostic and therapeutic tools for this age group are probably the greatest obstacles to define, diagnose and treat OSA in the elderly.

scholarly journals COT-16 INDICATION OF SYSTEMIC THERAPY FOR ELDER PATIENTS WITH BRAIN TUMORS: A SYSTEMATIC REVIEW AND PERSPECTIVE

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii43-ii43
Author(s):  
Yoko Nakasu ◽  
Koichi Mitsuya ◽  
Satoshi Nakasu ◽  
Kazuhiko Nozaki
Keyword(s):  
Elderly Patients ◽  
Systemic Therapy ◽  
Brain Tumours ◽  
Performance Status ◽  
The Elderly ◽  
Assessment Tools ◽  
Geriatric Population ◽  
Pubmed Database ◽  
Group 2 ◽  
Definition Of

Abstract BACKGROUND Little is known about indications and outcome prediction of systemic therapy for elderly patients with brain tumours. Clinical conditions of individuals are heterogenous from healthy to frail or diseased,moreover,are often reversible. METHOD We retrieved the literature of brain tumour,systemic therapy,chemotherapy,immunotherapy,in randomized controlled trials (RCTs) and reviews on PubMed database from 2008 to 2018. RESULTS 1) Definition of elderly by age in years: Depending on each protocol,the definition is arbitrary. Patients older than 60 or 70 years are usually in the elderly group. 2) Systemic evaluation: Performance status (PS) and visceral function are not sufficient to assess elderly patients. Assessment tools specifically developed for the geriatric population are recommended to evaluate individual patients. 3) Effects and toxicity of systemic therapy: Only a few RCT showed no inferiority of outcome in patients older than 60 or 65 years. There are only few evidences about the senile fragility of blood-brain barrier or distribution of drugs in the elderly brain. Molecular subtyping of brain tumours might predict the effects and toxicities of therapies for elderly patients. CONCLUSION Feasibility of modern systemic therapies are not well studied for elderly patients with brain tumours. Clinical condition varies in individual elderly patients. We need prospective studies of systemic therapy in elderly patients based on an eligibility with not only chronologic age but comprehensive geriatric assessments.

scholarly journals Determinants of treatment in patients with stage IV renal cell carcinoma

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Christopher S. Hollenbeak ◽  
Eric W. Schaefer ◽  
Justin Doan ◽  
Jay D. Raman
Keyword(s):  
Renal Cell Carcinoma ◽  
Elderly Patients ◽  
Cell Carcinoma ◽  
Systemic Therapy ◽  
Renal Cell ◽  
Stage Iv ◽  
Data Set ◽  
Causes Of Mortality ◽  
Competing Causes ◽  
Metastatic Rcc

Abstract Background Advances in systemic targeted therapies afford treatment opportunities in patients with metastatic renal cell carcinoma (RCC). Elderly patients with metastatic RCC present a subpopulation for consideration owing to competing causes of mortality and benefits seen with new therapeutic agents. We investigate treatment patterns for elderly patients with stage IV RCC and determine factors associated with not receiving treatment. Methods The Surveillance Epidemiology and End Results (SEER) Medicare linked data set contained 949 stage IV RCC patients over age 65 diagnosed between 2007 and 2011. Treatment approach was modeled using multinomial logistic regression. Landmark analysis at 6 months accounted for early death as a potential explanation for no treatment. Results Of the 949 patients with stage IV RCC, 26.2% received surgery and 34.1% received systemic therapy within 6 months of diagnosis. Among our entire cohort, over half (51.2%) had no evidence of receiving surgery or systemic therapy. Among the 447 patients who survived at least 6 months, 26.6% did not receive treatment during this time. Older patients and those with a higher Charlson Comorbidity Index (CCI) had lower odds of being treated with surgery, systemic therapy, or both. Conversely, married patients had higher odds of receiving these therapies. These associations were largely sustained in the 6-month landmark analyses. Conclusions Elderly patients with metastatic RCC present a unique subpopulation for consideration owing to competing causes of mortality. Many elderly patients with stage IV RCC did not receive surgery or systemic therapy up to 6 months from diagnosis. Several clinical and demographic factors were associated with this observation. Further investigation is needed to understand the rationale underlying the underutilization of systemic therapy in elderly patients.

scholarly journals Performance Evaluation of Different d-Dimer Cutoffs in Bedridden Hospitalized Elderly Patients

2016 ◽  
Vol 23 (8) ◽  
pp. 998-1004 ◽  
Author(s):  
Nevine A. Kassim ◽  
Tamer M. Farid ◽  
Shaimaa Abdelmalik Pessar ◽  
Salma A. Shawkat
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Age Group ◽  
Elderly Individuals ◽  
Clinical Probability ◽  
Hospitalized Elderly ◽  
Comparable Performance ◽  
Hospitalized Elderly Patients ◽  
Reduced Mobility ◽  
D Dimer

A rapid and accurate diagnosis of venous thromboembolism (VTE) in the elderly individuals represents a dilemma due to nonspecific clinical presentation, confusing laboratory results, and the hazards of radiological examination in this age-group. d-Dimer test is used mainly in combination with non-high clinical pretest probability (PTP) to exclude VTE. d-Dimer testing retains its sensitivity, however, its specificity decreases in the elderly individuals. Raising the cutoff level improves the specificity of the d-dimer test without compromising its sensitivity. The current study aimed to explore the reliability of higher d-dimer cutoff values for the diagnosis of asymptomatic VTE in a population of bedridden hospitalized elderly patients with non-high clinical PTP. This retrospective study included 252 bedridden hospitalized elderly patients (>65 years) who were admitted to the Ain shams University Specialized Hospital with non-high clinical probability and developed later reduced mobility; all underwent quantitation of d-dimer and Doppler examination. Considering the whole population (>65 years), the age-adjusted cutoff achieved the best performance in comparison with the conventional and receiver operating characteristic (ROC)–derived cutoffs. When stratified according to age, the age-adjusted cutoff showed the best performance in the age-group 65-70 and comparable performance with the ROC-derived cutoff in the age-group 71-80, however, its sensitivity compromised in those older than 80 years. In conclusion, it is recommended to use age-adjusted cutoff value of d-dimer together with the clinical probability score in elderly individuals (65-80 years).

Impact of adjuvant treatment in elderly patients with locally advanced rectal cancer: A population-based retrospective study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3613-3613
Author(s):  
Shiru Lucy Liu ◽  
Pierre O'Brien ◽  
Yizhou Zhao ◽  
Wilma M Hopman ◽  
Nathan William Dana Lamond ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Elderly Patients ◽  
Cox Regression ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
The Elderly ◽  
Population Based ◽  
Locally Advanced Rectal Cancer ◽  
Curative Intent ◽  
Kaplan Meier

3613 Background: Little is known about the benefit and use of adjuvant chemotherapy (ADJ) in the elderly population (age ≥ 65) with locally advanced rectal cancer (LARC). We undertook a provincial review of LARC patients to evaluate the potential benefits, including survival and time to relapse (TTR), of ADJ in elderly patients. Methods: We performed a retrospective analysis of 286 LARC patients (stage 2 and 3) diagnosed between January 2010 and December 2013 from Nova Scotia, Canada, who underwent curative-intent surgery. Baseline patient, tumor and treatment characteristics were collected. Survival and TTR analysis were performed using Kaplan-Meier and Cox-regression statistics. Results: 152 patients were age ≥65, and 92 age ≥70. Median follow-up was 46 months. 178 patients (62%) received neoadjuvant chemo-radiation (NEOADJ). While 109 patients (81%) age < 65 received ADJ, only 68 patients (45%) age ≥ 65 received ADJ. Kaplan-Meier analysis revealed a significant survival and TTR advantage for ADJ irrespective of age (table). In cox-regression multivariate analysis, ECOG status, T stage, and ADJ were significant predictors of survival (p < 0.04), while age was not. Similarly, N stage, NEOADJ, and ADJ were significant predictors of TTR (p < 0.007). Poor ECOG status was the most common cause of ADJ omission. There was a significantly higher amount of grade≥ 1 chemotherapy-related toxicity experienced by patients age ≥ 65 treated with ADJ compared to no ADJ (77% vs 32%, p < 0.0001), which consisted mostly of diarrhea and mucositis. Toxicity was the main reason for non-completion of ADJ in the elderly. Conclusions: Elderly patients with LARC have significantly improved overall survival with ADJ, but the use of ADJ is lower than in patients age < 65. However, elderly patients experience more chemotherapy-related toxicities, leading to higher rates of early treatment discontinuation. [Table: see text]

Survival outcomes in the elderly with limited stage diffuse large B-cell lymphoma treated with chemotherapy: SEER propensity-matched analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e19046-e19046
Author(s):  
Ravi Kaisreddy ◽  
Venkata Vosuri ◽  
Somasekhar Bandi
Keyword(s):  
Cox Regression ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Female Gender ◽  
The Elderly ◽  
Survival Outcomes ◽  
Age Group ◽  
Limited Stage ◽  
Large B Cell Lymphoma ◽  
Large B Cell

e19046 Background: Current data shows a median age of diffuse large b-cell lymphoma (DLBCL) diagnosis of 70 years. More than 50% of elderly DLBCL patients can be expected to be cured by modern immunochemotherapy. Survival outcomes in elderly patients with limited stage DLBCL treated with chemotherapy outside of clinical trials are poorly characterized. Our objective is to determine survival pattern and factors that influence survival in elderly patients with limited stage DLBCL treated with chemotherapy through analysis of data from a large nationwide cancer registry in modern treatment era. Methods: The Surveillance Epidemiology and End Results (SEER 18) treatment database (2001-2013) was used to detect limited stage (Ann Arbor lymphoma stage I and II) DLBCL (ICD-O-3 code: 9680/3) adult cases with ages between 60-80 years treated with chemotherapy. Patients were divided into two cohorts. Cohort 1 included patients aged ≥60 to 70 yrs and Cohort 2 included patients aged > 70 to 80 yrs. The variable "First Malignant Primary Indicator" was used to differentiate between primary DLBCL and secondary DLBCL cases. Overall survival (OS) was calculated using the Kaplan-Meier methods and multivariate cox regression model to determine the impact of race, gender, radiation use and primary malignant indicator on survival using 1:1 propensity score matching. Chi square test was applied to delineate for any significant difference between two cohorts. Results: Overall, 11138 patients were included with 5569 patients in each cohort. The relative incidence of limited stage secondary DLBCL was greater for cohort 2 when compared to cohort 1 (26% vs. 15%, p < 0.01). The odds of receiving radiation was 27% higher in cohort 1 compared to cohort 2 (p < 0.0001). Compared to cohort 1 (median OS-130 months), cohort 2 had worse median OS of 72 months (p < 0.0001). Female gender, not receiving radiation and secondary status have shown strong relationship with increased risk of death on multivariate cox regression analysis in the elderly limited stage DLBCL patients. Conclusions: Overall survival was worse in age group 70-80 yrs when compared to age group 60-70 yrs in limited stage DLBCL patients treated with chemotherapy. This may be due to differences in treatment approaches. Female gender, not receiving radiation and secondary status are poor prognostic factors of survival in above group of patients. Race has no impact on survival.

Time from stereotactic body radiotherapy to immunotherapy as a predictor for outcome in metastatic non small cell lung cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 9024-9024
Author(s):  
Rodney E Wegner ◽  
Stephen Abel ◽  
Shaakir Hasan ◽  
Richard White ◽  
Gene Grant Finley ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Median Survival ◽  
Stereotactic Body Radiotherapy ◽  
Cox Regression ◽  
Stage Iv ◽  
Small Cell ◽  
Small Cell Lung ◽  
Kaplan Meier

9024 Background: Immunotherapy has changed the face of treatment for stage IV non small cell lung cancer (NSCLC), quickly becoming the standard of care. The appropriate timing of immunotherapy in the setting of other ablative therapies, namely stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT), remains to be determined. We sought to use the National Cancer Database to examine trends in immunotherapy use as well as timing as it relates to SBRT/SRS in stage IV NSCLC patients. Methods: We queried the NCDB for patients with Stage IV NSCLC diagnosed between 2004-2015 that were treated with SRS or SBRT techniques (to any site) and had at least three months of follow up. Multivariable logistic regression was used to identify predictors of immunotherapy use. Receiver operator curve analysis was used to identify the optimal timepoint between SBRT and immunotherapy correlating with overall survival. Kaplan-meier curves were generated to determine overall survival. Multivariable cox regression was used to determine factors predictive of survival. A propensity score was generated and incorporated into Kaplan-meier and cox regressions to account for indication bias. Results: We identified 13,862 patients meeting the above eligibility criteria, 371 being treated with immunotherapy. The vast majority (75%) had chemotherapy as well. Patients with adenocarcinoma, treatment with chemotherapy, and more recent year of treatment were more likely to receive immunotherapy. Univariable Kaplan-meier analysis showed improved median survival with immunotherapy, 17 months vs. 13 months, p < 0.0001. On multivariable propensity-adjusted cox regression significant predictors for improved overall survival were younger age, lower comorbidity score, lower grade, private insurance, and female gender. Using a cutoff of 21 days after start of SBRT, patients treated thereafter were more likely to survive longer, median survival of 19 months vs 15 months, p = 0.0335. Conclusions: Immunotherapy use in Stage IV NSCLC after SBRT has increased over time, mostly in patients with adenocarcinoma and in the setting of chemotherapy. In this analysis, outcomes were improved when immunotherapy was given at least three weeks after start of SBRT.

Association of immune related adverse events with superior outcomes in patients with hepatocellular carcinoma (HCC) treated with nivolumab.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16630-e16630
Author(s):  
Lorena Ostios-Garcia ◽  
David Ramiro-Cortijo ◽  
Mary Linton Bounetheau Peters ◽  
Andrea J. Bullock
Keyword(s):  
Adverse Events ◽  
Cox Regression ◽  
Statistical Significance ◽  
Onset Time ◽  
Progression Free Survival ◽  
Categorical Variables ◽  
Rank Test ◽  
Cancer Outcomes ◽  
Exact Test ◽  
Kaplan Meier

e16630 Background: Nivolumab, an anti-PD1 antibody, is FDA approved in patients (pts) with HCC. Anti-PD-1 promotes hyperstimulation of host immunity and is associated with a spectrum of toxicities known as immune-related adverse events (irAEs). In other malignancies, higher rates of irAEs are associated with improved cancer outcomes. This study shows correlation between irAEs and efficacy in pts with HCC treated with nivolumab. Methods: Demographic and toxicity data were collected retrospectively on all pts with HCC treated with nivolumab at a single institution from Jan 2012 – Sept 2019. Response was evaluated using RECISTv1.1. Adverse events were assessed according to CTCAEv5.0. Categorical variables were assessed by Fisher's exact test. Survival was estimated with the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed by the Cox-regression model. Results: 30 pts were treated; irAEs were detected in 16 (53%). There was no difference in baseline characteristics among those who did and did not experience irAEs (Table). The most frequent irAEs were elevated AST/ALT (n = 7; 44%), rash (n = 4; 25%), and hypothyroid (n = 4; 25%). 3 G3 (rash and transaminitis) and 1 G4 AE (pured red cell apalasia) were observed. Among all pts, overall response rate (RR) and disease control rate (DCR) were 13 and 50%, respectively. Median progression free survival (PFS) and overall survival (OS) were 27 and 56 weeks (w), respectively. The RR and DCR were higher among irAEs vs non-irAEs, although this did not reach statistical significance (RR 25 vs 0%; p = 0.05; DCR 62 vs 35%; p = 0.19). Median PFS and OS were longer in those with irAEs vs non-irAE; PFS 33 vs 16 w (HR: 0.26; CI 95%: 0.076-0.89; p = 0.028); (OS 69 vs 21 w HR: 0.18; CI 95%: 0.05-0.58; p = 0.002). On multivariate analysis, viral etiology was associated with prolonged PFS (p = 0.002) and MELD was associated with reduced OS (p = 0.004). Conclusions: Development of irAEs was associated with prolonged PFS and OS in pts with HCC treated with nivolumab. Further study is needed to determine whether type of irAE, onset time, or duration affect cancer outcomes. [Table: see text]

scholarly journals Neurosarcoidosis Presenting With Recurrent Strokes

2016 ◽  
Vol 7 (2) ◽  
pp. 91-95 ◽  
Author(s):  
Naheed Raza ◽  
Karisa C. Schreck
Keyword(s):  
Risk Factors ◽  
Young People ◽  
Elderly Patients ◽  
Classification Scheme ◽  
The Elderly ◽  
Secondary Stroke Prevention ◽  
High Grade ◽  
Age Group ◽  
Vascular Risk ◽  
Recurrent Strokes

Neurosarcoidosis is a rare but important cause of stroke as it is treatable. Cases reported thus far have primarily been in young people who are relatively healthy. Here we report the case of a 73-year-old woman presenting with recurrent strokes and high-grade intracranial stenosis caused by probable neurosarcoidosis. This is unique as neurosarcoidosis is not usually considered as an etiology for recurrent strokes in our patient’s age-group. We review and categorize published cases of neurosarcoidosis causing stroke and describe a classification scheme for certainty of diagnosis. Given the implications of this diagnosis for secondary stroke prevention, we recommend that neurosarcoidosis be considered in the differential for patients with few vascular risk factors, recurrent strokes refractory to medical treatment, or possible vasculitis even in the elderly patients.

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