Advertisement

Elderly patients with gastrointestinal stromal tumour (GIST) receive less treatment irrespective of performance score or comorbidity – A retrospective multicentre study in a large cohort of GIST patients

Published:October 23, 2017DOI:https://doi.org/10.1016/j.ejca.2017.09.017

      Highlights

      • Elderly GIST patients receive less surgery and adjuvant treatment.
      • Adverse events in these patients result more often in treatment discontinuation.
      • Treatment is withheld or interrupted regardless of comorbidity or performance score.
      • As a result they have a relatively poor outcome.

      Abstract

      Objective

      Although gastrointestinal stromal tumours (GIST) predominantly occur in older patients, data on treatment patterns in elderly GIST patients are scarce.

      Methods

      Patients registered in the Dutch GIST Registry (DGR) from January 2009 until December 2016 were included. Differences in treatment patterns between elderly (≥75 years) and younger patients were compared. Multivariate analyses were conducted using logistic regression.

      Results

      Data of 145 elderly and 665 non-elderly patients were registered (median age 78 and 60 years respectively). In elderly patients, performance score (WHO-PS) and age-adjusted Charlson comorbidity index (ACCI) were significantly higher (p < 0.05; p < 0.001), and albumin level significantly lower (p = 0.04).
      Hundred-and-nine (75.2%) elderly and 503 (75.6%) non-elderly patients had only localised disease. Surgery was performed in 57% of elderly versus 84% of non-elderly patients (p = 0.003, OR: 0.26, 95% CI: 0.11–0.63). No differences in surgery outcome or complications were found. Thirty-eight percent of elderly with an indication for adjuvant treatment did receive imatinib versus 68% of non-elderly (p = 0.04, OR: 0.47, 95% CI: 0.23–0.95).
      Thirty-six elderly and 162 non-elderly patients had metastatic disease. Palliative imatinib was equally given (mean dose 400 mg) and adverse events were mostly minor (p = 0.71). In elderly, drug-related toxicity was in 32.7% reason to discontinue imatinib versus 5.1% in non-elderly (p = 0.001, OR 13.5, 95% CI: 2.8–65.0). Median progression-free survival (PFS) was 24 months in elderly and 33 months in non-elderly (p = 0.10). Median overall survival (OS) was 34 months and 59 months respectively (p = 0.01).

      Conclusions

      Elderly GIST patients with localised disease receive less surgery and adjuvant treatment, irrespective of comorbidity and performance score. Drug-related toxicity results more often in treatment discontinuation. This possibly results in poor outcome.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Corless C.L.
        Gastrointestinal stromal tumors: what do we know now?.
        Mod Pathol [Internet]. 2014; 27 (Nature Publishing Group. Available from:): S1-S16
        • IKNL
        Cijfers over kanker.
        ([Internet])2016: 2015-2017 (Available from:)
        • Centraal Bureau voor de Statistiek
        Prognose periode-levensverwachting; geslacht en leeftijd 2014–2060.
        ([Internet])2014 (Available from:)
        • Joensuu H.
        • Hohenberger P.
        • Corless C.L.
        Gastrointestinal stromal tumour.
        Lancet [Internet]. 2013; 382 (Elsevier Ltd. Available from:): 973-983
        • Italiano A.
        • Saada E.
        • Cioffi A.
        • Poulette S.
        Treatment of advanced gastrointestinal stromal tumors in patients over 75 years old: clinical and pharmacological implications.
        Target Oncol. 2013; 8: 295-300
        • Casali P.G.
        • Blay J.Y.
        Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
        Ann Oncol [Internet]. 2014; 25 (Available from:): iii21-iii26
        • Demetri G.D.
        • von Mehren M.
        • Antonescu C.R.
        • DeMatteo R.P.
        • Ganjoo K.N.
        • Maki R.G.
        • et al.
        NCCN task force report: update on the management of patients with gastrointestinal stromal tumors.
        J Natl Compr Canc Netw. 2010; 8 (quiz S42–4): S1-S41
        • Harlan L.C.
        • Eisenstein J.
        • Russell M.C.
        • Stevens J.L.
        Gastrointestinal stromal tumors: treatment patterns of a population-based sample.
        J Surg Oncol. 2015; 111: 702-707
        • Denewet N.
        • De Breucker S.
        • Luce S.
        • Kennes B.
        • Pepersack T.
        • Denewet N.
        • et al.
        Comprehensive geriatric assessment and comorbidities predict survival in geriatric oncology comprehensive geriatric assessment and comorbidities predict survival in geriatric oncology.
        Acta Clin Belg. 2016; 71: 2006-2213
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Balducci L.
        Geriatric oncology: challenges for the new century.
        Eur J Cancer. 2000; 36: 1741-1754
        • Le Saux O.
        • Falandry C.
        • Gan H.K.
        • You B.
        • Freyer G.
        • Péron J.
        Inclusion of elderly patients in oncology clinical trials.
        Ann Oncol. 2016; 27: 1799-1804
        • Miettinen M.
        • Lasota J.
        Gastrointestinal stromal tumors: pathology and prognosis at different sites.
        Semin Diagn Pathol [Internet]. 2006; 23 (Available from:): 70-83
        • Tjan-Heijnen V.
        • Kerst J.M.
        • Eskens F.
        • Guchelaar H.J.
        • van der Hoeven J.J.M.
        • Pruijt J.F.M.
        • et al.
        Adjuvante therapie met imatinib bij GIST.
        Med Oncol. 2011; 3: 33-35
        • Yang T.
        • Hou M.
        • Chen P.
        • Hsin I.
        Clinical outcomes and complications of endoscopic submucosal dissection for superficial gastric neoplasms in the elderly.
        Medicine (Baltimore). 2015; 94: e1964
        • Milone M.
        • Elmore U.
        • Musella M.
        • Parise P.
        • Zotti M.
        • Bracale U.
        • et al.
        Safety and efficacy of laparoscopic wedge gastrectomy for large gastrointestinal stromal tumors.
        Eur J Surg Oncol. 2017; 43: 796-800
        • Joensuu H.
        • Vehtari A.
        • Riihimäki J.
        • Nishida T.
        • Steigen S.E.
        • Brabec P.
        • et al.
        Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts.
        Lancet Oncol [Internet]. 2012; 13 (Available from:): 265-274
        • Joensuu H.
        • Eriksson M.
        • Sundby Hall K.
        • Hartmann J.T.
        • Pink D.
        • Schutte J.
        • et al.
        One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial.
        JAMA [Internet]. 2012; 307: 1265-1272https://doi.org/10.1001/jama.2012.347
        • Kramer K.
        • Knippschild U.
        • Mayer B.
        • Bögelspacher K.
        • Spatz H.
        • Henne-bruns D.
        • et al.
        Impact of age and gender on tumor related prognosis in gastrointestinal stromal tumors (GIST).
        BMC Cancer. 2015; 15: 57
        • Demetri G.D.
        • Wang Y.
        • Wehrle E.
        • Racine A.
        • Nikolova Z.
        • Blanke C.D.
        • et al.
        Imatinib plasma levels are correlated with clinical benefit in patients with unresectable/metastatic gastrointestinal stromal tumors.
        J Clin Oncol. 2009; 27: 3141-3147
        • Bouchet S.
        • Poulette S.
        • Titier K.
        • Moore N.
        • Lassalle R.
        • Abouelfath A.
        • et al.
        Relationship between imatinib trough concentration and outcomes in the treatment of advanced gastrointestinal stromal tumours in a real-life setting.
        Eur J Cancer. 2016; 57: 31-38
        • Blay J.
        • Rutkowski P.
        Adherence to imatinib therapy in patients with gastrointestinal stromal tumors.
        Cancer Treat Rev [Internet]. 2014; 40 (Elsevier Ltd): 242-247https://doi.org/10.1016/j.ctrv.2013.07.005
        • Breccia M.
        • Luciano L.
        • Latagliata R.
        • Castagnetti F.
        • Ferrero D.
        • Cavazzini F.
        • et al.
        Age influences initial dose and compliance to imatinib in chronic myeloid leukemia elderly patients but concomitant comorbidities appear to influence overall and event-free survival.
        Leuk Res [Internet]. 2014; 38 (Elsevier Ltd): 1173-1176https://doi.org/10.1016/j.leukres.2014.06.020