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“The primary results were presented at [the 2024] ASCO [Annual Meeting], but here, we presented the analysis that focused on the quality of life and geriatric assessment factors at baseline and evaluated the correlation with their survival [for] patients on the trial. The study showed that there were very clear findings in the baseline assessment that had a strong correlation with survival, and that included function, nutrition and depression.”

Efrat Dotan, MD, executive medical director, Ann B. Barshinger Cancer Institute, Penn Medicine, Lancaster General Health, discusses findings from a secondary analysis of the phase 2 ECOG-ACRIN EA2186 (GIANT) trial (NCT04233866) evaluating gemcitabine plus nab-paclitaxel (Abraxane) vs 5-fluorouracil, leucovorin, and liposomal irinotecan (Onivyde) in older patients with treatment-naive metastatic pancreatic cancer.

Dotan notes that this analysis examined the correlation between baseline geriatric and quality-of-life (QOL) assessments with survival outcomes in this population. Functional status, nutritional status, and depression scores were identified as key predictive factors for survival, independent of ECOG performance status. Additionally, Dotan explains that all QOL measures correlated with overall survival (OS), highlighting the importance of baseline assessments in guiding treatment decisions.

 demonstrated no significant difference in median OS between the treatment arms, with OS of 4.7 months (95% CI, 4.1-7.4) in the gemcitabine/nab-paclitaxel cohort and 4.4 months (95% CI, 3.1-8.9) in the fluoropyrimidine-based cohort (HR, 1.12; 95% CI, 0.76-1.66; 

 = .72). The median progression-free survival (PFS) was 3.0 months (95% CI, 1.9-4.3) vs 2.4 months (95% CI, 1.9-3.7), respectively (HR, 1.10; 95% CI, 0.79-1.53; 

 = .58). However, among patients who received at least 4 weeks of therapy, median OS improved to 8.0 months (95% CI, 5.9-10.0).

Dotan emphasizes that the QOL findings from the study support the integration of geriatric assessments into routine oncology practice to improve patient selection and optimize supportive care strategies. She highlights the potential to enhance outcomes by addressing baseline vulnerabilities, improving QOL, and providing tailored supportive care.

Videos

Efrat Dotan, MD, discusses gemcitabine plus nab-paclitaxel vs 5-fluorouracil, leucovorin, and liposomal irinotecan in older patients with metastatic pancreatic cancer.

 Dr Dotan on the Prognostic Value of QOL Assessments in Older Patients with Pancreatic Cancer

Dr Dotan on Treating Geriatric Patients With Gastroesophageal Cancer

Efrat Dotan, MD, chief, Division of Gastrointestinal (GI) Medical Oncology, associate professor, Department of Hematology/Oncology, associate director, Hematology/Oncology Fellowship Training Program, Fox Chase Cancer Center, discusses data from a retrospective study presented during the 

 that aimed to to understand the needs of geriatric patients with gastroesophageal cancer.

These findings serve as an expected revelation

, yet they significantly contribute to the comprehension of the prevailing unmet needs within the geriatric gastroesophageal cancer clinical setting, Dotan begins. These findings underscore the necessity for deeper contemplation or heightened attention during patient evaluations, she expains, adding that oncologists have gained valuable insights into the specific areas that warrant more scrutiny and consideration within clinical practice.

In an effort to broaden the scope of this research, an additional investigation was incorporated into the study design, Dotan reports. This investigation entailed conducting an exploratory analysis wherein elderly patients were tasked with wearing a Fitbit for a duration of 4 days, enabling an objective assessment of their physical function. Notably, 85% of the participants wore the Fitbit for longer periods of time than the predefined duration needed to meet the primary end point of feasibility, providing valuable data for analysis, she explains. It was found that patients who averaged approximately 2500 steps per day experienced distinct challenges compared with their more active counterparts, a factor likely to significantly impact their overall outcomes, she emphasizes.

The impetus behind this exploratory analysis stemmed from a desire to explore alternative, more objective methods of patient evaluation, in contrast to subjective questionnaires, which may be influenced by various biases or prove cumbersome to administer in a clinical setting, Dotan continues. It is hoped that this study will contribute to the growing body of evidence emphasizing the imperative for clinicians caring for elderly patients to adopt a comprehensive treatment approach, she expresses. Beyond addressing patients’ primary ailments, consideration must be given to the broader spectrum of factors influencing patient care, encompassing overall health, lifestyle, and individual circumstances, Dotan concludes. This holistic perspective is essential for optimizing patient outcomes and ensuring comprehensive care delivery in clinical practice.

Efrat Dotan, MD, discusses a retrospective study aiming to understand the needs of geriatric patients with gastroesophageal cancer.

Efrat Dotan, MD, discusses the use of geriatric function assessments in elderly patients with gastroesophageal cancer.

Dr Dotan on the Use of Geriatric Assessments to Identify Unique Challenges in GI Cancer

Efrat Dotan, MD, chief, Gastrointestinal (GI) Medical Oncology, associate professor, Department of Hematology/Oncology, associate director, Hematology/Oncology Fellowship Training Program, Fox Chase Cancer Center, discusses the utility of geriatric function assessment when identifying geriatric challenges and predicting outcomes in elderly patients with gastroesophageal cancer.

Geriatric assessments can help oncologists determine whether older patients with GI cancers are fit for anti-cancer therapy, Dotan begins. Accordingly, Dotan and colleagues conducted a study to compare patient-identified challenges through the use of geriatric assessments vs those identified through physician evaluations in routine clinical practice. The study was also designed to identify unique unmet needs in the elderly population and explore how abnormalities identified in geriatric assessments correlated with treatment outcomes, Dotan details. A total of 82 patients aged 65 years of age or older with any-stage gastroesophageal cancer were included in the study.

showed that clinical characteristics of older patients with gastroesophageal cancer were not found to be predictive of abnormalities in geriatric assessments, Dotan reports. Such findings suggest a significant disparity between the findings of geriatric assessments and those identified by physicians during routine clinical practice, she explains.Although physicians were adept at recognizing medical comorbidities, they often overlooked critical psychosocial, cognitive, and functional issues affecting patients, Dotan continues. Importantly, the study elucidated a clear correlation between these unidentified abnormalities and adverse treatment outcomes, including increased rates of treatment-related toxicities, hospitalizations, and other complications, she notes.

These findings underscore the importance of adopting a holistic approach to patient care, particularly for elderly cancer patients, through the use of comprehensive geriatric assessments, Dotan emphasizes. Such an approach can help healthcare providers better understand and address the diverse challenges faced by these patients, thereby ensuring comprehensive care delivery and optimized treatment outcomes, Dotan concludes.

Efrat Dotan, MD

Articles

Dr Dotan on the Prognostic Value of QOL Assessments in Older Patients with Pancreatic Cancer

Dr Dotan on Treating Geriatric Patients With Gastroesophageal Cancer

Dr Dotan on the Use of Geriatric Assessments to Identify Unique Challenges in GI Cancer