SAN FRANCISCO — Frailty indices predict overall survival and toxicity among older adults with cancer receiving chemotherapy.
“Given the increased use of immunotherapy and targeted therapy for advanced non-small cell lung cancer (aNSCLC), we evaluated frailty and Karnofsky Performance Status (KPS) among older adults with aNSCLC receiving chemotherapy, immunotherapy, and/or targeted therapy,” wrote researchers from the University of California, San Francisco, and the San Francisco VA Healthcare System and colleagues.
In their study, patients age 65 and older with aNSCLC starting systemic therapy with noncurative intent underwent geriatric assessments over 6 months.
The study team developed a deficit-accumulation frailty index to group patients into three categories:
- robust,
- pre-frail
- frail.
Among 155 patients (median age 73), 45.8% were robust, 36.1% pre-frail and 18.2% frail; 34.8% had a KPS ≥ 90, 32.9% had a KPS of 80, and 32.3% had a KPS ≤ 70, the researchers advised in the Oncologist journal.1
The median OS was 17.9 months, they note, adding, “Pre-frail/frail patients had worse OS compared to robust patients (adjusted hazard ratio [HR] 2.09, 95% CI, 1.31-3.34) and were more likely to be hospitalized (adjusted odds’ ratio [OR] 2.21, 95% CI, 1.09-4.48), functionally decline (adjusted OR 2.29, 95% CI, 1.09-4.78), and experience grade ≥ 3 hematologic toxicity (adjusted OR 5.18, 95% CI, 1.02-26.03). KPS was only associated with OS.”
The authors concluded, “Our frailty index was associated with OS, hospitalization, functional decline, and hematologic AEs among older adults with aNSCLC receiving systemic therapies, while KPS was only associated with OS. Pretreatment frailty assessment may help identify older adults at risk for poor outcomes to optimize decision-making and supportive care.”
- Lee HJ Jr, Boscardin J, Walter LC, Smith AK, et. Al. Associations of frailty with survival, hospitalization, functional decline, and toxicity among older adults with advanced non-small cell lung cancer. Oncologist. 2024 Dec 9:oyae349. doi: 10.1093/oncolo/oyae349. Epub ahead of print. PMID: 39657913.
