Internal Medicine, Geriatry and Therapeutic Unit, AP-HM, Marseille, France;Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France.
Aix-Marseille Université, CNRS, EFS, ADES, Marseille, France.
Clin Interv Aging. 2020 Sep 8;15:1587-1598. doi: 10.2147/CIA.S262209. eCollection 2020.
Polymorbidity induces polypharmacy in older patients may lead to potential drug-drug interactions (DDI) which can modify the tolerance and safety of oncological treatments and alter the intended therapeutic effect. The objective of our study was to describe the decision-making process for oncological treatment and related outcomes, in a population of older adults undergoing a comprehensive geriatric assessment (CGA) associated to a comprehensive medication reconciliation (CMR) prior to initiating oncological treatment.
ChimioAge is a prospective observational study conducted between 01/2017 and 07/2018 at Marseille University Hospital and approved by the French National Ethics Committee. It comprised all consecutive patients aged 70 years and over who were referred for a CGA as part of CMR, before initiating systemic treatment.
One hundred and seventy-one cancer patients were included. Mean age was 79.2 years, over half had metastatic cancers, 75% had an ECOG performance status zero or one, and two-thirds were independent in daily activities. Two-thirds of the patients had polypharmacy and the CMR identified potential DDI with systemic treatment in 43.3% of patients. Following the CGA, the CMR and the hospital oncologists decision, 30% of the patients received adapted systemic treatment with reduced doses at initiation. They presented fewer toxicities - irrespective of grade and type - than patients who received standard treatment (p<0.001) and had comparable overall survival (Log rank p=0.21).
This is one of the first studies to highlight the value in conducting CMR and a CGA simultaneously before initiating systemic treatment in older patients with cancer. These two evaluations could give oncologists decisive information to personalize cancer treatment of older patients and optimize treatment dose to offer the best efficacy and minimize toxicity.
老年患者的多病共存会导致多种药物并用，这可能会引发潜在的药物相互作用（DDI），从而改变抗肿瘤治疗的耐受性和安全性，并改变预期的治疗效果。本研究的目的是描述在进行综合老年评估（CGA）和全面药物重整（CMR）以确定开始抗肿瘤治疗之前，对接受综合老年评估的老年患者进行抗肿瘤治疗的决策过程和相关结局。
ChimioAge 是一项前瞻性观察性研究，于 2017 年 1 月至 2018 年 7 月在马赛大学医院进行，得到了法国国家伦理委员会的批准。该研究纳入了所有年龄在 70 岁及以上、因 CMR 而接受 CGA 并准备开始全身治疗的连续患者。
共纳入 171 例癌症患者，平均年龄为 79.2 岁，超过一半的患者为转移性癌症，75%的患者 ECOG 表现状态为 0 或 1，三分之二的患者日常生活活动能力独立。65%的患者有多种药物并用，CMR 发现 43.3%的患者与全身治疗存在潜在的 DDI。在 CGA、CMR 和医院肿瘤医生决策之后，30%的患者接受了起始剂量降低的适应性全身治疗。他们的毒性反应较少，无论毒性类型和严重程度（p<0.001），与接受标准治疗的患者相比，他们的总生存率相当（Log rank p=0.21）。
这是在开始对老年癌症患者进行全身治疗之前同时进行 CMR 和 CGA 的首批研究之一。这两项评估可为肿瘤医生提供有价值的信息，以个性化老年癌症患者的治疗方案，并优化治疗剂量，以达到最佳疗效并最大限度减少毒性。
