S46Toxicity of targeted therapy in elderly patients

Background: The elderly have been under-represented in clinical trials for cancer therapy, even in the era of targeted therapy. It is widely believed that targeted therapy, which interferes with specific pathways required for tumor development and growth, is more effective and less toxic than cytotoxic chemotherapy. Patients and methods: This retropsective-observational study analyzed 53 pts who were 70 years old or older and were diagnosed with NSCLC, RCC and HCC candidate to receive targeted therapy at our Oncology Unit from January 2012 to December 2015. 3 pts (5.7%) received pazopanib, 12 pts (22.6%) received sorafenib, 9 pts (17%) received sunitinib, 9 pts (17%) received gefitinib and 20 pts (37.7%) received erlotinib. 39 pts (73.6%) received targeted therapy as first line and 14 pts (26.4%) as second line. All grade of hematological and non hematological toxicities were examined. Median Overall Survival and time to progression and for specific cancer were calculated using the Kapler-Meier method. Relevant clinical variables (Age, CIRS-G co-morbidity index, many drugs, dose reduction, hematological and non hematological toxicities, and line treatment) have been collected. Results: Toxicities were generally mild. 35 pts (66%) had no hematological toxicities; 6 pts presented hematological toxicity G1 (11.3%); 11 pts G2 (20,8%), 1 pt G3 (1,9%). Considering non hematological toxicity: 6 pts didn't present it (11.3%), 13 pts (24,5%) presented G1, 23 pts G2 (43,4%), 11 pts G3 toxicity (20.8%). 30 pts (56,6%) received a reduced dose. Median OS was 475 days (95%CI, 242-707) and Median TTP was 210 (95%CI, 152- 267). OS and TTP were calculated for specific cancer. OS was 1391 days for RCC (95%CI, 775-2006), 309 days for HCC (95%CI, 0-638), 437 days for NSCLC (95%CI, 111-762). The TTP was 352 days for RCC (95%CI, 25-678), 111 for HCC (95%CI, 57-164), 217 days for NSCLC (95%CI, 152-281). CIRS-G co-morbidities index comorbidities (p = .008,), non-hematologica toxicity (p = .002) and dose reduction (p = .001) were independent prognostic factors using the Cox regression model. Conclusions: Based on this study targeted therapy (sorafenib, sunitinib, pazopanib, erlotinib and gefitinib) should be administered to the elderly. These targeted therapies have demonstrated to be safe and effective. Dose modification should be made when necessary. Comorbidities should be considered in any case especially in this group of pts.