Frailty predicts chemotherapy toxicity in seniors with NSCLC
Frailty predicts toxicity during the first cycle of chemotherapy in elderly adults with nonsmall cell lung cancer (NSCLC), a recent study has shown. Relevant assessments may be used to evaluate toxicity risk regardless of chronologic age.
Using a modified cancer-specific geriatric assessment (GA) toxicity risk score, researchers evaluated toxicity risk in 48 newly diagnosed NSCLC patients (mean age 68.5±9.5 years; 79.2 percent male) undergoing chemotherapy. The treatment regimen included carboplatin and 200 mg/m2 paclitaxel every 3 weeks.
Over one-fourth (27.1 percent) of the patients were identified as frail, as tested by the Fried Frailty Index (FFI). Majority (84 percent) met at least one of the five criteria for frailty. Self-reported physical limitations were also common: 31.3 percent of the participants reported needing assistance for instrumental activities of daily living.
Treatment-related toxicities grade 3–5 were reported in 68.8 percent of the patients during the first two chemotherapy cycles. In patients who underwent more than one cycle, 28.6 percent and 11.9 percent required dose reductions and dose delays, respectively, attributed to toxicities in the first two cycles.
Hospitalization as a result of the first two chemotherapy cycles was reported in 18.8 percent of the participants. The most common primary causes for hospitalization included infections (33 percent), fatigue/dehydration (22.2 percent), pleural effusion (11.1 percent) and electrolyte abnormalities (11.1 percent), among others.
Using multivariate Cox proportional hazards models, researchers identified a score of FFI ≥3 as a significant and independent predictor of grade 3–5 toxicity in the first chemotherapy cycle (odds ratio [OR], 7.0; 95 percent CI, 1.1–44.6). FFI had the same effect in patients who completed the second cycle and had no dose reductions (OR, 10.22; 1.24–84.27).