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Management of gastric cancer in vulnerable patients: Is there a particularity?
Background
Gastric cancer is the third leading cause of cancer death in the world and the fourth in Marrakech with an ASIR of 4.15 per 100.000 residents. It is frequently diagnosed in the elderly and is associated with rapid deterioration of general health. Management of this frail population has always been a challenge because being less included in trials. The aim of our study is to make a descriptive analysis regarding the management of frail patients.
Methods
We conducted a descriptive retrospective study evaluating 62 vulnerable patients diagnosed with gastric cancer between 2020-2021 at the medical oncology department of the Mohammed VI University Hospital in Marrakech-Morocco. Vulnerable patients were defined by an age ≥ 70 years old and/or those with a performance status ≥ 2.
Results
Between 2020-2021, 150 patients were diagnosed with gastric cancer, only 62 patients were included in this study. Most of our patients were males (60% vs 40%). The average age at diagnosis was 64 years of which 35 patients (56.4%) were aged ≥ 70 years and 48 (77%) had a PS ≥ 2. 19 patients (30.6%) had comorbidities. For elderly patients: 31 (88.5%) had a G8 score ≤ 14. The most frequent histological type was adenocarcinoma 57 (92%), of which 12 (21%) were in the form of signet ring cell type. 30.6% of the patients had locally advanced tumor and 63% had metastatic tumor. 35 of patients (56.5%) received chemotherapy, of which 83% received bi-chemotherapy such as CAPOX or FOLFOX in 86% of the cases and 17% received CAPECITABINE as a monotherapy. 12% underwent surgery after neoadjuvant chemotherapy, 18 patients (29%) were declared palliative care due to deterioration of general condition (PS 3-4), and 8 patients (13%) were lost to follow-up. Among patients who received chemotherapy: 33.60% presented chemotherapy induced toxicities including peripheral neuropathy G1-G2 in 33% of cases, 24% with G1-G4 neutropenia, 24% with asthenia 14% with G1 diarrhea. Data of first PFS and Overall survival are not mature, further follow-up is needed to provides these results.
Conclusions
In our study, age was not an indicator for not giving chemotherapy. However, the decision to administer chemotherapy depended on the performance status. Bi-chemotherapy was not associated with excessive toxicity.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
