Geriatric Assessment-guided therapy modification and outcomes in patients with non-metastatic gastroesophageal cancer: a retrospective cohort study☆

Background

Despite aggressive multimodal treatment for locally advanced esophagogastric cancer (LA-EGC), many patients experience early disease progression/death. We aimed to explore the role of Geriatric Assessment (GA) in optimizing patient care in older patients with LA-EGC.

Materials and methods

A retrospective cohort study was conducted in patients aged ≥60 years with LA-EGC referred to the geriatric oncology clinic at our institute between June 2018 and November 2022, who were planned for curative treatment. We explored the role of GA-guided therapy modifications on survival, identification of factors predicting potential ‘overtreatment’ (arbitrarily defined as patients in whom disease recurrence or death occurred within 6 months of treatment completion), and utility of the GA in identification of this patient subset.

Results

We enrolled 199 patients. The median age was 68 years (interquartile range 64-73 years). There were 131 (65.8%) males and 157 patients (78.9%) had a performance status of 0-1. Based on the GA, 110 (55.3%) patients were deemed fit (≤2 domains affected). Therapy modification (primarily de-intensification) occurred in 72 (36.2%) patients. At a median follow-up of 34.1 months [95% confidence interval (CI) 31.5-36.7 months], median event-free survival with de-intensified treatment was 12.2 months (95% CI 9.1-15.3 months) versus 18.8 months (95% CI 14.7-22.9 months) with standard treatment; P = 0.113. Median overall survival was 15.4 months (95% CI 9.3-21.5 months) with de-intensified treatment versus 21.1 months (95% CI 16.1-26.1 months) with standard treatment, P = 0.116. Six months following treatment completion, 79 (39.7%) patients were potentially overtreated. Initial GA failed to identify patients who were potentially overtreated (P = 0.923).

Conclusion

GA-tailored treatment de-escalation does not impair survival in older patients with LA-EGC but fails to identify the patient cohort at risk for overtreatment.