Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2015; 21(16): 4911-4918
Published online Apr 28, 2015. doi: 10.3748/wjg.v21.i16.4911
Palliative chemotherapy for gastroesophageal cancer in old and very old patients: A retrospective cohort study at the National Center for Tumor Diseases, Heidelberg
Anne Katrin Berger, Stefanie Zschaebitz, Christine Komander, Dirk Jäger, Georg Martin Haag
Anne Katrin Berger, Stefanie Zschaebitz, Dirk Jäger, Georg-Martin Haag, National Center for Tumor Diseases, Heidelberg University Hospital, 69120 Heidelberg, Germany
Christine Komander, NCT Clinical Cancer Registry, German Cancer Research Center, 69120 Heidelberg, Germany
Author contributions: Berger AK participated in study concepts and design, data acquisition, data analysis and interpretation, manuscript preparation and editing; Haag GM participated in data analysis and interpretation, manuscript preparation, quality control of data and algorithms and statistical analysis; Komander C participated in data acquisition and manuscript preparation; Jäger D and Zschaebitz S participated in data analysis and interpretation and manuscript preparation and review; all authors read and approved the final manuscript.
Supported by Zentrum für Geriatrische Onkologie und Biologie in der Metropolregion Rhein Neckar (ZOBEL).
Ethics approval: The study was approved by the local Ethics Committee (Ethics Committee University of Heidelberg; S-335/2014, 28.07.2014).
Informed consent: According to local ethics policy for retrospective analysis of own anonymized clinical data, IC was not obtained.
Conflict-of-interest: The authors state that there is no conflict of interest to disclose.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Anne Katrin Berger, National Center for Tumor Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany.
Telephone: +49-6221-567229 Fax: +49-6221-567225
Received: October 8, 2014
Peer-review started: October 9, 2014
First decision: November 14, 2014
Revised: December 3, 2014
Accepted: December 19, 2014
Article in press: December 22, 2014
Published online: April 28, 2015

AIM: To investigate the outcome of palliative chemotherapy in old patients with gastroesophageal cancer at the National Center for Tumor Diseases, Heidelberg.

METHODS: Using a prospectively generated database, we retrospectively analyzed 55 patients ≥ 70 years under palliative chemotherapy for advanced gastroesophageal cancer at the outpatient clinic of the National Center for Tumor Diseases Heidelberg, Germany between January 2006 and December 2013. Further requirements for inclusion were (1) histologically proven diagnosis of gastroesophageal cancer; (2) advanced (metastatic or inoperable) disease; and (3) no history of radiation or radiochemotherapy. The clinical information included Eastern Cooperative Oncology Group performance status (ECOG PS), presence and site of metastases at diagnosis, date of previous surgery and perioperative chemotherapy, start and stop date of first-line treatment, toxicities and consecutive dosage reductions of first-line treatment, response to first-line therapy, date of progression, usage of second-line therapies and date and cause of death. Survival times [progression-free survival (PFS), overall survival (OS) and residual survival (RS)] were calculated. Toxicity and safety were examined. Prognostic factors including ECOG PS, age and previous perioperative treatment were analyzed.

RESULTS: Median age of our cohort was 76 years. 86% of patients received a combination of two cytotoxic drugs. 76 percent of patients had an oxaliplatin-based first-line therapy with the oxaliplatin and 5-fluorouracil regimen being the predominantely chosen regimen (69%). Drug modifications due to toxicity were necessary in 56% of patients, and 11% of patients stopped treatment due to toxicities. Survival times of our cohort are in good accordance with the major phase III trials that included mostly younger patients: PFS and OS were 5.8 and 9.5 mo, respectively. Survival differed significantly between patient groups with low (≤ 1) and high (≥ 2) ECOG PS (12.7 mo vs 3.8 mo, P < 0.001). Very old patients (≥ 75 years) did not show a worse outcome in terms of survival. Patients receiving second-line treatment (51%) had a significantly longer RS than patients with best supportive care (6.8 vs 1.4 mo, P = 0.001). Initial ECOG PS was a strong prognostic factor for PFS, OS and RS.

CONCLUSION: Old patients with non-curable gastroesophageal cancer should be offered chemotherapy, and ECOG PS is a tool for balancing benefit and harm upfront. Second-line treatment is reasonable.

Keywords: Gastroesophageal cancer, Old patients, Palliative chemotherapy, Toxicity, Eastern Cooperative Oncology Group performance status

Core tip: Data concerning efficacy and safety of palliative chemotherapy for gastroesophageal cancer in patients ≥ 70 years are scarce. Concerns about poor tolerability due to reduced functional status are common, and older patients are at risk for undertreatment. In our analysis of 55 patients ≥ 70 years, the survival times were in good accordance to the results of the landmark phase III trials including younger patients. Except for increased polyneuropathy, toxicity rates were also comparable. Initial Eastern Cooperative Oncology Group performance status was a strong prognostic factor for PFS, OS and RS.