UK national observational cohort study investigating Tolerance of Anti-cancer Systemic Therapy in the Elderly: the TOASTIE study

TY - JOUR

T1 - UK national observational cohort study investigating Tolerance of Anti-cancer Systemic Therapy in the Elderly

T2 - the TOASTIE study

AU - Baxter, Mark

AU - Rowe, Michael

AU - Zucker, Kieran

AU - Peters, Adam L.

AU - Rohan, Maria

AU - Marsh, Alexandra

AU - Gee, Abigail L.

AU - Quesne, Gemma

AU - Heseltine, Jonny

AU - Prichard, Rachel

AU - Scott, Deborah

AU - O'Neill, Conor

AU - Brunner, Clair

AU - Howells, Joni

AU - Conteh, Veronica

AU - Aujayeb, Avinash

AU - Yan, Xiangfei

AU - Rodgers, Lisa J.

AU - Martin, Sally

AU - Dearden, Helen

N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2024.

PY - 2024/8/29

Y1 - 2024/8/29

N2 - Objective The Cancer and Aging Research Group (CARG) score was developed to predict severe chemotherapy-induced toxicity risk in older adults; validation study results have varied. The Tolerance of Anti-cancer Systemic Therapy in the Elderly study sought to evaluate the CARG score prospectively in a chemotherapy-naïve UK population. Methods and analysis This multicentre, prospective, observational study recruited patients aged ≥65 years commencing first-line chemotherapy for any solid organ malignancy or setting. Baseline demographics and established frailty measures were recorded. Follow-up data including toxicity and hospital admissions were collected retrospectively. Baseline CARG score predictive ability was assessed. Results 339 patients were recruited from 19 centres; median age 73 years (range 65–92), 51.9% male and 54.9% gastrointestinal primary. At baseline, 85% of patients were of Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0–1, with median Rockwood Clinical Frailty Scale (CFS) 3 (range 0–8). 314 (92.6%) patients had follow-up data; 69 (22.3%) patients experienced Common Terminology for Cancer Adverse Events grade ≥3 toxicity and 84 (27%) required hospital admission during treatment. Increasing CARG risk groups had increased grade ≥3 toxicity (low 19.6%, medium 22.2%, high 28.2%); however, this was non-significant with no evidence of robust predictive performance. Predictive performance of CFS and ECOG PS was superior to CARG. Importantly, patient and clinician perceptions of toxicity risk differed significantly. Conclusions In older UK patients with cancer commencing chemotherapy, baseline frailty was prevalent. CARG score did not robustly discriminate or predict high-grade toxicity risk. ECOG and CFS showed superior, although limited, ability to predict and discriminate. This study highlights the need for the development of tools that better predict toxicity in this population.

AB - Objective The Cancer and Aging Research Group (CARG) score was developed to predict severe chemotherapy-induced toxicity risk in older adults; validation study results have varied. The Tolerance of Anti-cancer Systemic Therapy in the Elderly study sought to evaluate the CARG score prospectively in a chemotherapy-naïve UK population. Methods and analysis This multicentre, prospective, observational study recruited patients aged ≥65 years commencing first-line chemotherapy for any solid organ malignancy or setting. Baseline demographics and established frailty measures were recorded. Follow-up data including toxicity and hospital admissions were collected retrospectively. Baseline CARG score predictive ability was assessed. Results 339 patients were recruited from 19 centres; median age 73 years (range 65–92), 51.9% male and 54.9% gastrointestinal primary. At baseline, 85% of patients were of Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0–1, with median Rockwood Clinical Frailty Scale (CFS) 3 (range 0–8). 314 (92.6%) patients had follow-up data; 69 (22.3%) patients experienced Common Terminology for Cancer Adverse Events grade ≥3 toxicity and 84 (27%) required hospital admission during treatment. Increasing CARG risk groups had increased grade ≥3 toxicity (low 19.6%, medium 22.2%, high 28.2%); however, this was non-significant with no evidence of robust predictive performance. Predictive performance of CFS and ECOG PS was superior to CARG. Importantly, patient and clinician perceptions of toxicity risk differed significantly. Conclusions In older UK patients with cancer commencing chemotherapy, baseline frailty was prevalent. CARG score did not robustly discriminate or predict high-grade toxicity risk. ECOG and CFS showed superior, although limited, ability to predict and discriminate. This study highlights the need for the development of tools that better predict toxicity in this population.

KW - Older adults with cancer

KW - systemic anti-cancer therapy

KW - toxicity

KW - chemotherapy

KW - frailty

UR - https://www.scopus.com/pages/publications/85206263465

U2 - 10.1136/bmjonc-2024-000459

DO - 10.1136/bmjonc-2024-000459

M3 - Article

C2 - 39886166

SN - 2044-6055

VL - 3

JO - BMJ Open

JF - BMJ Open

IS - 1

M1 - e000459

ER -