Abstract Details

Title Treatment Recommendations and Estimation of Toxicity in Older Patients with Glioblastoma

Topic Neuro-oncology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 11-001

Objective Describe provider treatment decisions and estimation of toxicity independent of geriatric assessment (GA) in older adults with glioblastoma (GBM).

Background Older adults (>/=65) with GBM are vulnerable to over and under treatment and increased toxicity. Geriatric assessment predicts toxicity in patients with cancer, but data is limited in neuro-oncology.

Design/Methods IRB-approved prospective study of 26 older adults with GBM enrolled at a single academic institution. Patients completed GA prior to treatment including G8 geriatric screen and comprehensive geriatric assessment (CGA). Providers recommended treatment and estimated toxicity based on clinical judgement and independent of GA. Demographics and treatment intolerance (delays, cessation or modification) were collected. Ordinal logistic regressions evaluated if G8 or CGA components were associated with treatment recommendation or treatment intolerance.

Results

19/26 were men, median age 73, 11 MGMT methylated, 7 gross total resection, 9 subtotal, 10 biopsy. 77% (20/26) had G8 score </= 14, indicating need for CGA. Disease-directed therapy was recommended for all patients. Of patients with G8 </= 14, 5% (1/20) were recommended for clinical trial, 35% (7/20) 6 weeks radiation + chemotherapy, 35% (7/20) 3 weeks radiation + chemotherapy, and 25% (5/20) 3 weeks radiation alone. There was no association between G8 score or CGA components and treatment recommendation. 54% (14/26) experienced treatment intolerance; 13/20 who received radiation + chemotherapy and 1/6 who received radiation alone. The most common toxicity was fatigue requiring chemotherapy dose modification. Age was predictive of treatment intolerance (p=0.048). Providers predicted treatment intolerance 54% (14/26) of the time.

Conclusions Treatment recommendations based on clinical judgement were independent of GA, suggesting that providers did not detect geriatric vulnerabilities found on G8 or CGA in majority of older patients with GBM. Treatment toxicity is common in older patients with GBM and underestimated by providers. Prospective studies should evaluate whether GA can guide treatment recommendations and reduce toxicity.

Authors/Disclosures
Lauryn Hemminger (Strong Memorial Hospital) PRESENTER	Dr. Hemminger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion.
Wade J. Whitt	Mr. Whitt has nothing to disclose.
Sarah Cawley	Miss Cawley has nothing to disclose.
Jacqueline M. Behr, NP (University of Rochester Medical Center)	Mrs. Behr has nothing to disclose.
Jennifer N. Serventi, PA (University Of Rochester Medical Center)	Ms. Serventi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novocure.
Andrea C. Wasilewski, MD (Givens Brain Tumor Center)	Dr. Wasilewski has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novocure. Dr. Wasilewski has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Servier Pharmaceuticals .
Nimish A. Mohile, MD, FAAN	The institution of Dr. Mohile has received research support from Novocure.
Sara Hardy, MD (University of Washington)	Dr. Hardy has received research support from the American Cancer Society.

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