Optimizing chemotherapy for older adults with advanced cancer

Standard chemotherapy regimens, which are mostly based on testing in relatively young and healthy patients, may do more harm to older adults with cancer who often struggle with other health issues. New research, published yesterday in JAMA Network Open, shows that lowering the dose and adjusting the schedule of how chemotherapy is given to older adults with advanced cancer can make life better for patients, without compromising their treatment goals.

The study, which was led by researchers from the University of Rochester Medical Center's Wilmot Cancer Institute, focuses on how well older people tolerate chemotherapy. More than 30 percent of patients benefitted from treatment regimen modifications that helped them avoid toxic side effects and retain the ability to perform daily functions for themselves, such as bathing, dressing, eating, and walking.

Wilmot researchers Mostafa R. Mohamed, MD, PhD, and Supriya G. Mohile, MD, MS, led the study, which analyzed data from more than 600 study participants over the age of 70 who participated in the national clinical trial known as GAP70+.

Nearly half of all GAP70+ participants received a modified treatment regimen, defined as any treatments that deviated from the National Comprehensive Cancer Network guidelines or published clinical trials. Lower doses and altered chemotherapy schedules were the most common modifications identified in the study.

Compared with patients who received standard treatment regimens, patients who had modified treatments had a 15 percent reduced risk of serious clinician-rated toxic effects and a 20 percent reduced risk of patient-reported functional decline. Patients with modified treatment regimens also had 32 percent lower odds of having a worse composite adverse outcome, which suggests the treatment modification did not compromise efficacy.

This study is among just a handful of such studies that exclusively focus on older adults with advanced cancer who receive chemotherapy. Authors believe this information can help healthcare providers as choose the best care plans for older patients with advanced cancer.