Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA; W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, USA.
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
J Geriatr Oncol. 2019 Jan;10(1):48-54. doi: 10.1016/j.jgo.2018.06.007. Epub 2018 Jul 10.
Improved assessment strategies are needed to individualize treatment for adults of all ages receiving palliative chemotherapy for non-small cell lung cancer (NSCLC). Our aim was to evaluate the utility of the Fried Frailty Index (FFI) and a cancer-specific geriatric assessment (GA) to predict chemotherapy toxicity and overall survival (OS).
We conducted a multi-site pilot study of 50 patients with newly diagnosed advanced NSCLC, age ≥ 18 years. All participants received carboplatin AUC 6, paclitaxel 200 mg/m every 3 weeks. FFI and the GA were administered prior to chemotherapy. A GA toxicity risk score was calculated. Grade 3-5 toxicity was assessed during 1st two cycles of chemotherapy. OS was measured from chemotherapy initiation. Logistic regression and Cox proportional hazards models were fit to estimate the association between baseline characteristics and toxicity and OS respectively.
Among 50 participants, 48 received chemotherapy and were evaluable. The mean age was 68.5 y (range 42-86), 79% male, 85% KPS ≥80. The median OS was 8 months. Many (27%) met FFI criteria for frailty with ≥3 impairments. Impairments detected by the GA were common. In multivariable analyses both FFI ≥ 3 and GA toxicity risk score > 7 were independently associated with higher odds of toxicity (Odds ratio [OR] 7.0; 95% confidence interval [CI] 1.1-44.6 and OR 4.3; 95% CI 1.0-17.7, respectively) in first cycle chemotherapy. Neither score was associated with OS.
Frailty predicts chemotherapy toxicity during first cycle. Frailty assessment may inform toxicity risk regardless of chronologic age.
需要改进评估策略，以便为接受非小细胞肺癌（NSCLC）姑息化疗的所有年龄段的成年人进行个体化治疗。我们的目的是评估 Fried 衰弱指数（FFI）和特定于癌症的老年评估（GA）在预测化疗毒性和总生存期（OS）方面的效用。
我们对 50 名新诊断为晚期 NSCLC 的患者进行了多站点试点研究，年龄≥18 岁。所有患者均接受卡铂 AUC 6、紫杉醇 200mg/m2，每 3 周一次。在化疗前进行 FFI 和 GA。计算 GA 毒性风险评分。在第 1 至 2 个化疗周期中评估 3-5 级毒性。从化疗开始测量 OS。Logistic 回归和 Cox 比例风险模型分别用于估计基线特征与毒性和 OS 之间的关联。
在 50 名参与者中，有 48 名接受了化疗且可评估。平均年龄为 68.5 岁（范围为 42-86），79%为男性，85%的 KPS≥80。中位 OS 为 8 个月。许多（27%）符合 FFI 定义的衰弱标准，有≥3 项缺陷。GA 检测到的缺陷很常见。在多变量分析中，FFI≥3 和 GA 毒性风险评分>7 均与第 1 周期化疗毒性的可能性增加独立相关（优势比[OR] 7.0；95%置信区间[CI] 1.1-44.6 和 OR 4.3；95% CI 1.0-17.7）。两个评分均与 OS 无关。
衰弱预测第 1 周期的化疗毒性。衰弱评估可能会根据年龄提供毒性风险信息，而与实际年龄无关。
