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HER2-low breast cancers in older women (³70 years): Biology and clinical outcome compared to younger patients (<70 years) 老年妇女(70岁以上)的her2低乳腺癌:与年轻患者(<70岁)相比的生物学和临床结果
IF 2.7 3区 医学 Q3 GERIATRICS & GERONTOLOGY Pub Date : 2026-03-01 Epub Date: 2026-03-13 DOI: 10.1016/j.jgo.2026.102865
I. Tretter Alvarez de Arcaya , B. Syed , E. Rakha , A. Green , K.-L. Cheung , R. Parks
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引用次数: 0
Representation of older adults in registrational trials associated with therapeutic approvals in follicular lymphoma 与滤泡性淋巴瘤治疗批准相关的注册试验中老年人的代表性
IF 2.7 3区 医学 Q3 GERIATRICS & GERONTOLOGY Pub Date : 2026-03-01 Epub Date: 2026-03-13 DOI: 10.1016/j.jgo.2026.102872
R. Juthani , K. Pugh , N.R. Neuendorff , P. Torka
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引用次数: 0
First-line modified-FOLFIRI plus bevacizumab or panitumumab in older patients with metastatic colorectal cancer: Results of two parallel phase II trials from Hellenic Oncology Research Group 一线改良folfiri联合贝伐单抗或帕尼单抗治疗老年转移性结直肠癌:来自希腊肿瘤研究小组的两项平行II期试验的结果
IF 2.7 3区 医学 Q3 GERIATRICS & GERONTOLOGY Pub Date : 2026-03-01 Epub Date: 2026-03-13 DOI: 10.1016/j.jgo.2026.102873
A. Karampeazis, L. Vamvakas, A. Kotsakis, N. Vardakis, E. Kontopodis, J. Souglakos, D. Chatzidaki, V. Georgoulias, Hellenic Oncology Research Group
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引用次数: 0
Feasibility and acceptability of a novel intervention to improve communication for older adults with dual diagnoses of dementia and cancer along with their care partners 一种新的干预措施的可行性和可接受性,以改善痴呆症和癌症双重诊断的老年人及其护理伙伴的沟通
IF 2.7 3区 医学 Q3 GERIATRICS & GERONTOLOGY Pub Date : 2026-03-01 Epub Date: 2026-03-13 DOI: 10.1016/j.jgo.2026.102887
A. Magnuson , A. Job , J. Bauer , J. Mortimer , E. Nguyen , S. Hryniv , H. D'Aurizio , N. Dukelow , L. Berkhof , R. Gelb , R. Epstein , B. Kluger , K. Heffner , M. Sohn , L. Wang , E. Ramsdale , S. Kadambi , K.P. Loh , M. Janelsins , S. Mohile
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引用次数: 0
Survivorship care delivery for older patients with cancer: An evaluation of community oncology clinics enrolled in a nationwide trial in the United States 老年癌症患者的生存护理:美国一项全国性试验中对社区肿瘤诊所的评估
IF 2.7 3区 医学 Q3 GERIATRICS & GERONTOLOGY Pub Date : 2026-03-01 Epub Date: 2026-03-13 DOI: 10.1016/j.jgo.2026.102864
S. Mohile , K.P. Loh , A. Magnuson , M. Wells , C. Hoffman , R. Tylock , F. Stauffer , C. Braun-Inglis , J.O. Hopkins , M. Weiss , P.-J. Lin , S. Yilmaz , K. Mustian , M. Janelsins
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引用次数: 0
Efficacy and safety of neoadjuvant dual anti-HER2 therapy in older patients with HER2-positive breast cancer: A real-world retrospective analysis 新辅助双重抗her2治疗在老年her2阳性乳腺癌患者中的疗效和安全性:一项现实世界的回顾性分析
IF 2.7 3区 医学 Q3 GERIATRICS & GERONTOLOGY Pub Date : 2026-03-01 Epub Date: 2026-03-13 DOI: 10.1016/j.jgo.2026.102883
L.S.J. Au , Y.N. Zhang , K. Yeung , K.L. Cheung , W.L. Chan
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引用次数: 0
A literature review on hypothalamic–pituitary–adrenal (HPA) axis dysregulation in older adults with cancer: A missing link in predicting treatment toxicity? 关于老年癌症患者下丘脑-垂体-肾上腺(HPA)轴失调的文献综述:预测治疗毒性的缺失环节?
IF 2.7 3区 医学 Q3 GERIATRICS & GERONTOLOGY Pub Date : 2026-03-01 Epub Date: 2026-01-24 DOI: 10.1016/j.jgo.2026.102854
Len De Nys
Older adults with cancer face disproportionately high rates of severe treatment-related toxicities, yet current prediction tools rarely incorporate biomarkers that capture physiological resilience. The hypothalamic–pituitary–adrenal (HPA) axis—central to stress adaptation, immune regulation, and tissue repair—undergoes pronounced age-related alterations, including elevated basal cortisol, reduced dehydroepiandrosterone (DHEA) and its sulphate form DHEAS, and an increased cortisol:DHEA(S) ratio. These changes may impair immune function, delay recovery, and exacerbate vulnerability to treatment toxicity. This narrative review synthesizes mechanistic and clinical evidence linking HPA-axis dysregulation to treatment tolerance in geriatric oncology. Common patterns include blunted diurnal cortisol slopes, elevated evening cortisol, and low DHEA(S), which are associated with fatigue, functional decline, and reduced survival across cancer types. However, their predictive value for acute treatment toxicities remains underexplored due to methodological heterogeneity, lack of age-specific reference ranges, and absence from existing geriatric toxicity models. This review proposes a translational roadmap that prioritizes (1) standardization of salivary cortisol/DHEA(S) protocols; (2) prospective, age-stratified validation studies using standardized toxicity endpoints; (3) interventional testing of behavioral or pharmacological strategies to modulate HPA function; and (4) integration into oncology workflows and electronic decision-support tools. Incorporating endocrine biomarkers into risk prediction could refine treatment stratification, enable targeted supportive care, and ultimately improve outcomes for older patients with cancer.
患有癌症的老年人面临着不成比例的高比例的严重治疗相关毒性,但目前的预测工具很少纳入捕捉生理弹性的生物标志物。下丘脑-垂体-肾上腺(HPA)轴-应激适应、免疫调节和组织修复的中心-经历明显的年龄相关改变,包括基础皮质醇升高,脱氢表雄酮(DHEA)及其硫酸盐形式DHEAS减少,皮质醇:DHEA(S)比率增加。这些变化可能损害免疫功能,延缓恢复,并加剧对治疗毒性的易感性。这篇叙述性综述综合了hpa轴失调与老年肿瘤治疗耐受性之间的机制和临床证据。常见的模式包括昼夜皮质醇斜率变钝、夜间皮质醇升高和低脱氢表雄酮(S),这与疲劳、功能下降和癌症类型的生存率降低有关。然而,由于方法学的异质性,缺乏年龄特异性参考范围,以及缺乏现有的老年毒性模型,它们对急性治疗毒性的预测价值仍未得到充分探讨。本综述提出了一个翻译路线图,优先考虑(1)唾液皮质醇/脱氢表雄酮(S)协议的标准化;(2)使用标准化毒性终点的前瞻性年龄分层验证研究;(3)干预测试调节HPA功能的行为或药物策略;(4)整合肿瘤学工作流程和电子决策支持工具。将内分泌生物标志物纳入风险预测可以细化治疗分层,实现有针对性的支持性护理,并最终改善老年癌症患者的预后。
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引用次数: 0
Effect of geriatric co-management on independence, quality of life, and severe toxicity in vulnerable older patients with cancer: Results of a randomized clinical trial 老年共同管理对易感老年癌症患者独立性、生活质量和严重毒性的影响:一项随机临床试验的结果
IF 2.7 3区 医学 Q3 GERIATRICS & GERONTOLOGY Pub Date : 2026-03-01 Epub Date: 2026-02-04 DOI: 10.1016/j.jgo.2026.102896
Gabriele Ihorst , Elisabeth Jentschke , Kathrin Tatschner , Carmen Roch , Birgitt van Oorschot , Peter Baier , Bernhard Geyer , Miriam Hüttmeyer , Christoph Hohlbein , Anna Heckers , Johanna Gerber , Barbara Deschler-Baier

Introduction

Cancer treatment puts older adults with cancer at increased risk for functional decline, impaired quality of life (QOL), and treatment-related toxicity. Geriatric co-management has been proposed as a strategy to improve outcomes in this vulnerable population.

Materials and methods

This prospective, randomized (1:1) trial evaluated the impact of geriatric co-management and intervention in patients aged ≥70 years with a G8 score < 15 initiating new systemic outpatient treatment. The aim was to assess the efficacy of targeted interventions versus standard care. Two primary endpoints were chosen: independence (no restrictions in instrumental activities of daily living (IADL)) and QOL (global health scale of the European Organisation for the Research and Treatment of Cancer questionnaire: EORTC QLQ-C30) at 12 weeks (T2). Secondary endpoint was “incidence of severe adverse events” (Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0, grade ≥ 3). A multiprofessional team performed the geriatric assessment and co-management in the intervention group (IG).

Results

A total of 217 patients were enrolled (207 in full analysis set; median age 75 (range 70–89) years; 42% female). For both primary endpoints, a tendency for improvement in the IG was observed: an adjusted odds ratio (OR) of 1.34 (97.5% CI 0.60–2.98; p = 0.42) for regaining independence, and an adjusted difference in global QOL T2 scores of 1.82 (CI -4.44-8.07; p = 0.51). Statistical significance could not be demonstrated. Geriatric co-management reduced grade ≥ 3 toxicities compared with standard care (15.5% vs 30.8% of patients, risk difference − 15.2%, 95% CI -26.5%; −3.9%) and lowered unplanned hospitalizations (21.4% vs 28.8% of patients, risk difference − 7.5%, 95% CI -19.3%; 4.3%).

Discussion

The interventions showed a consistent, yet statistically insignificant, impact on quality of life and independence. Importantly, it was associated with a reduction in severe toxicity and may have led to fewer unplanned hospitalizations. Findings support further integration of geriatric co-management into routine oncology care for older adults with cancer.
癌症治疗使老年癌症患者的功能下降、生活质量(QOL)受损和治疗相关毒性的风险增加。老年人共同管理已被提议作为一种战略,以改善这一弱势群体的结果。材料和方法:这项前瞻性、随机(1:1)试验评估了老年联合管理和干预对年龄≥70岁、评分为G8的患者的影响。结果:共有217例患者入组(完整分析集207例),中位年龄75岁(70-89岁);42%的女性)。对于两个主要终点,观察到IG的改善趋势:恢复独立性的调整优势比(OR)为1.34 (97.5% CI 0.60-2.98; p = 0.42),全球生活质量T2评分的调整差异为1.82 (CI -4.44-8.07; p = 0.51)。统计学意义无法证明。与标准治疗相比,老年联合治疗降低了≥3级的毒性(15.5% vs 30.8%的患者,风险差- 15.2%,95% CI -26.5%; -3.9%),降低了计划外住院(21.4% vs 28.8%的患者,风险差- 7.5%,95% CI -19.3%; 4.3%)。讨论:这些干预措施对生活质量和独立性的影响是一致的,但在统计上并不显著。重要的是,它与严重毒性的减少有关,并可能导致计划外住院的减少。研究结果支持进一步将老年共同管理纳入老年癌症患者的常规肿瘤护理。
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引用次数: 0
Tolerability of immune checkpoint inhibitors for cancer treatment in frail, older patients 免疫检查点抑制剂对虚弱老年患者癌症治疗的耐受性。
IF 2.7 3区 医学 Q3 GERIATRICS & GERONTOLOGY Pub Date : 2026-03-01 Epub Date: 2025-12-15 DOI: 10.1016/j.jgo.2025.102829
Rochelle Sheppard , Christopher Anstey , Leila Hanjani , Rahul Ladwa , Robin Berry , James Fletcher , Ruth Hubbard

Introduction

Immune checkpoint inhibitors (ICIs) are increasingly used in older adults, but tolerability among frail patients remains uncertain. This study examined immune-related adverse events (irAEs) and treatment outcomes in frail and non-frail adults aged ≥65 years.

Materials and methods

A retrospective single-centre review was conducted at Princess Alexandra Hospital (Queensland, Australia) of patients aged ≥65 who commenced at least one cycle of ICI between December 2021 and July 2023. Frailty was assessed using the Australian 58-item Frailty Index (FI) (non-frail <0.25, frail ≥0.25). The primary outcome was any irAE as defined by Common Terminology Criteria for Adverse Events (CTCAE v5). Secondary outcomes included treatment discontinuation, cycles, interruptions, and corticosteroid use. Univariable and multivariable logistic regression modelling was performed, adjusting for age, sex, cycles, tumour type, stage, concurrent therapy, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS).

Results

Of 122 adults (mean age 75.8 years, 66.4 % male), 51 (41.8 %) were frail. Twenty patients were still receiving ICIs and had not yet completed treatment at last census, leaving 102 records with evaluable outcomes for the final modelling. Any irAE occurred in 53 non-frail adults (74.7 %) and 28 frail adults (54.9 %) (adjusted OR 0.41, 95 % CI 0.19–0.89, p = 0.02). Non-frail adults had more grade 1 events (62.0 % vs 43.1 %, p = 0.045) and skin-related events (48 % vs 27 %, p = 0.04). Grade ≥ 3 events occurred in 11.3 % non-frail vs 11.8 % frail (OR 1.10, 95 % CI 0.38–3.17). Early discontinuation was 60.6 % in non-frail vs 74.5 % in frail (OR 1.90, 95 % CI 0.86–4.19, p = 0.12). Median cycles were 10 (IQR 4–16) in non-frail vs 6 (IQR 4–11) in frail (p = 0.04).

Discussion

Frailty (FI ≥0.25) was associated with fewer irAEs, but frail adults received fewer cycles. These findings are exploratory and should be interpreted cautiously as differences in exposure likely confound toxicity comparisons; time-to-event analyses are warranted.
免疫检查点抑制剂(ICIs)越来越多地用于老年人,但虚弱患者的耐受性仍不确定。这项研究调查了年龄≥65岁的体弱和非体弱成年人的免疫相关不良事件(irAEs)和治疗结果。材料和方法:在亚历山德拉公主医院(昆士兰,澳大利亚)对年龄≥65岁且在2021年12月至2023年7月期间至少开始一个周期ICI的患者进行了回顾性单中心评价。使用澳大利亚58项虚弱指数(FI)评估虚弱(非虚弱结果:122名成年人(平均年龄75.8岁,男性占66.4 %),51人(41.8%)虚弱。在最后一次人口普查中,20名患者仍在接受综合免疫系统,尚未完成治疗,留下102份记录,可供最终建模评估。53名非体弱成人(74.7%)和28名体弱成人(54.9%)发生了irAE(校正OR 0.41, 95% CI 0.19-0.89, p = 0.02)。非虚弱的成年人有更多的1级事件(62.0% vs 43.1%, p = 0.045)和皮肤相关事件(48% vs 27%, p = 0.04)。发生≥3级事件的非虚弱患者为11.3%,虚弱患者为11.8% (OR 1.10, 95% CI 0.38-3.17)。非虚弱组早期停药率为60.6%,虚弱组为74.5% (OR 1.90, 95% CI 0.86-4.19, p = 0.12)。非虚弱组中位周期为10 (IQR 4-16),虚弱组为6 (IQR 4-11) (p = 0.04)。讨论:虚弱(FI≥0.25)与较少的irae相关,但虚弱的成年人接受较少的周期。这些发现是探索性的,应谨慎解释,因为暴露的差异可能混淆毒性比较;时间到事件的分析是必要的。
{"title":"Tolerability of immune checkpoint inhibitors for cancer treatment in frail, older patients","authors":"Rochelle Sheppard ,&nbsp;Christopher Anstey ,&nbsp;Leila Hanjani ,&nbsp;Rahul Ladwa ,&nbsp;Robin Berry ,&nbsp;James Fletcher ,&nbsp;Ruth Hubbard","doi":"10.1016/j.jgo.2025.102829","DOIUrl":"10.1016/j.jgo.2025.102829","url":null,"abstract":"<div><h3>Introduction</h3><div>Immune checkpoint inhibitors (ICIs) are increasingly used in older adults, but tolerability among frail patients remains uncertain. This study examined immune-related adverse events (irAEs) and treatment outcomes in frail and non-frail adults aged ≥65 years.</div></div><div><h3>Materials and methods</h3><div>A retrospective single-centre review was conducted at Princess Alexandra Hospital (Queensland, Australia) of patients aged ≥65 who commenced at least one cycle of ICI between December 2021 and July 2023. Frailty was assessed using the Australian 58-item Frailty Index (FI) (non-frail &lt;0.25, frail ≥0.25). The primary outcome was any irAE as defined by Common Terminology Criteria for Adverse Events (CTCAE v5). Secondary outcomes included treatment discontinuation, cycles, interruptions, and corticosteroid use. Univariable and multivariable logistic regression modelling was performed, adjusting for age, sex, cycles, tumour type, stage, concurrent therapy, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS).</div></div><div><h3>Results</h3><div>Of 122 adults (mean age 75.8 years, 66.4 % male), 51 (41.8 %) were frail. Twenty patients were still receiving ICIs and had not yet completed treatment at last census, leaving 102 records with evaluable outcomes for the final modelling. Any irAE occurred in 53 non-frail adults (74.7 %) and 28 frail adults (54.9 %) (adjusted OR 0.41, 95 % CI 0.19–0.89, <em>p</em> = 0.02). Non-frail adults had more grade 1 events (62.0 % vs 43.1 %, <em>p</em> = 0.045) and skin-related events (48 % vs 27 %, p = 0.04). Grade ≥ 3 events occurred in 11.3 % non-frail vs 11.8 % frail (OR 1.10, 95 % CI 0.38–3.17). Early discontinuation was 60.6 % in non-frail vs 74.5 % in frail (OR 1.90, 95 % CI 0.86–4.19, <em>p</em> = 0.12). Median cycles were 10 (IQR 4–16) in non-frail vs 6 (IQR 4–11) in frail (<em>p</em> = 0.04).</div></div><div><h3>Discussion</h3><div>Frailty (FI ≥0.25) was associated with fewer irAEs, but frail adults received fewer cycles. These findings are exploratory and should be interpreted cautiously as differences in exposure likely confound toxicity comparisons; time-to-event analyses are warranted.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"17 2","pages":"Article 102829"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of surgically resectable colorectal liver metastases in older patients 老年患者可手术切除的结直肠肝转移的处理
IF 2.7 3区 医学 Q3 GERIATRICS & GERONTOLOGY Pub Date : 2026-03-01 Epub Date: 2025-12-20 DOI: 10.1016/j.jgo.2025.102840
Sara Myers , Ponnandai Somasundar , Clark DuMontier , Dae Hyun Kim , Steve Kwon
Surgical resection offers a curative treatment option for patients with colorectal cancer liver metastases (CRLM), but data on resection of CRLM among older patients is conflicting and sparse. The older population is heterogenous, and no age-calibrated guidelines for management of surgically resectable CRLM exist. Age-related physiologic changes to the liver include impaired tissue growth, increased oxidative stress and inflammation, and dysregulated metabolic homeostasis. Cumulatively, these changes to the liver microenvironment lead to decreased regeneration ability of the liver and higher vulnerability to the stress of surgery. Systemic chemotherapy may also be associated with worse hepatotoxicity among older patients. Given the combination of age-related physiological changes and chemotherapy-associated hepatotoxicity, evaluating both the volume and the function of the future liver remnant (FLR) among older patients is critically important. Additionally, older patients may have higher risks for both medical and surgical postoperative complications including following CRLM resection. Liver-directed therapy, including transarterial chemoembolization (TACE), transarterial delivery of irinotecan-coated beads (DEBIRI), hepatic infusion chemotherapy (HAI), as well as radiation and ablation therapy are well-tolerated and may be offered to older patients. Discussions of CRLM resection and treatment options should be paired with goals of care conversations for older patients, including wishes surrounding both quantity and quality of life, and functional outcomes. Some older patients, including frail individuals or those with limited life expectancies, may benefit more from liver-directed therapy than from surgical management of CRLM. Shared-decision making tools may be helpful for discussing potential post-operative issues with older patients, including quality-adjusted life expectancy, the potential for loss of independent living, and stays in long-term care facilities following CRLM resection in addition to morbidity and mortality.
手术切除为结直肠癌肝转移(CRLM)患者提供了一种治愈性的治疗选择,但关于老年患者的CRLM切除的数据是相互矛盾和稀少的。老年人群是异质性的,没有针对可手术切除的CRLM管理的年龄校准指南。与年龄相关的肝脏生理变化包括组织生长受损、氧化应激和炎症增加以及代谢稳态失调。累积起来,肝脏微环境的这些变化导致肝脏再生能力下降,对手术应激的易感性增加。在老年患者中,全身化疗也可能与更严重的肝毒性有关。考虑到年龄相关的生理变化和化疗相关的肝毒性,评估老年患者未来肝残体(FLR)的体积和功能至关重要。此外,老年患者发生包括CRLM切除术在内的内科和外科术后并发症的风险更高。肝定向治疗,包括经动脉化疗栓塞(TACE),经动脉给药伊立替康包被珠(DEBIRI),肝输注化疗(HAI),以及放疗和消融治疗耐受性良好,可以提供给老年患者。CRLM切除和治疗方案的讨论应与老年患者的护理对话目标相结合,包括围绕生活数量和质量的愿望,以及功能结果。一些老年患者,包括体弱个体或预期寿命有限的患者,可能从肝脏定向治疗中获益比从CRLM的手术治疗中获益更多。除发病率和死亡率外,共同决策工具可能有助于讨论老年患者的潜在术后问题,包括质量调整预期寿命、丧失独立生活的可能性、CRLM切除术后在长期护理机构的停留时间。
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引用次数: 0
期刊
Journal of geriatric oncology
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