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
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Article info
Publication history
Published online: October 23, 2017
Accepted:
September 6,
2017
Received in revised form:
September 5,
2017
Received:
June 1,
2017
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
