Dose-finding in older and frail patients, not extrapolation from fit ones
The dose for a frail 80-year-old is guessed from what fit 55-year-olds tolerated. Running dose-finding in older patients directly, using frailty assessment, would give doses they can actually take.
Dedicated dose-finding and dose-comparison cohorts in patients aged 75 and over or with frailty on geriatric assessment, run in parallel with or after the main dose-finding, using tolerability, function and QoL alongside efficacy. The GO2 trial in advanced oesophago-gastric cancer showed that reduced-intensity chemotherapy in frail and older patients was non-inferior with better QoL, demonstrating the approach.
- Wrong doses · Most drug doses were chosen as the highest a person can tolerate, which is often more than they need.
- Older and multimorbid patients are excluded and undertreated · Most people with cancer are over 65 but most trial patients are younger and fitter. We guess how to treat the majority.
Pages like this
not linked directly; found by shared links- IdeaUpfront reduced-dose regimens tested head-to-head in frail older patients
Shares GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth, Older and multimorbid patients are excluded and undertreated, Wrong doses, Cytotoxic chemotherapy.
- IdeaGeriatric assessment by default for every older patient, and trials that admit them
Shares GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth, Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaGeriatric assessment by default for every patient over 70 starting cancer treatment
Shares GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth, Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaA mandatory over-70s cohort with geriatric assessment in every pivotal trial
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated, Wrong doses.
- IdeaDedicated cohorts for patients with performance status 2 in first-line trials
Shares Older and multimorbid patients are excluded and undertreated, Oesophageal cancer, Gastric & gastro-oesophageal junction cancer.
- IdeaGeriatrician co-management for older patients having cancer surgery
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaParallel real-world cohorts for sicker patients alongside every pivotal trial
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaStop screening by life expectancy, not birthday, with a tool in the record
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.