Treatment Tolerability in Older Adults With Advanced Cancer Receiving Geriatric Assessment-Guided Versus Oncologist-Guided Primary Treatment Modification: Secondary Analysis of the GAP70+ Trial.
retrospective_cohort · Level III
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- Also identified by DOI 10.1200/OP-25-01364.
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Abstract
Primary treatment modification (PTM; changes in treatment dose or agents from standard guidelines) is common among older adults with advanced cancer because of aging-related vulnerabilities. Geriatric assessment evaluates aging-related factors to inform personalized treatment. We compared treatment tolerability between PTM guided by geriatric assessment-guided management (PTM-GAM) and PTM determined by usual oncologic care (PTM-UC). This secondary analysis of the GAP70+ study (ClinicalTrials.gov identifier: NCT02054741; PI: Mohile) was restricted to patients age 70+ years with incurable solid tumors who initiated systemic therapy with a PTM (N=298). PTM-GAM (n = 169) was guided by GA results and management recommendations, whereas PTM-UC (n = 129) was based solely on oncologist evaluation. Tolerability outcomes within 3 months of treatment initiation included grade 3 to 5 toxicity, secondary dose reduction (any unplanned decrease in dose after treatment initiation), decline in activities of daily living (ADL), and unplanned hospitalization. Associations were evaluated using multivariable cluster-weighted generalized estimating equation models. The mean age was 77 years, and GI cancers were most common (37%). Overall, 59% experienced ≥1 grade 3 to 5 toxicity. Compared with PTM-UC, PTM-GAM was associated with a lower risk of grade 3 to 5 toxicity (relative risk, 0.77 [95% CI, 0.65 to 0.91]). Secondary dose reductions occurred in 22% of patients, with lower risk in PTM-GAM (RR, 0.47 [95% CI, 0.30 to 0.72]). PTM-GAM was associated with a nonsignificant reduction in unplanned hospitalization (RR, 0.69 [95% CI, 0.45 to 1.03]). No difference was observed in ADL decline (RR, 1.04 [95% CI, 0.74 to 1.48]). Older adults with advanced cancer who received GA-guided PTM had a 23% lower risk of grade 3 to 5 toxicities and a 53% lower risk of secondary dose reduction compared with PTM based on usual oncologic care. These findings underscore the role of geriatric assessment in optimizing treatment decisions and improving tolerability.