Br J Cancer: Geriatric intervention (CGA) can improve the chemotherapy prognosis of elderly patients with colorectal cancer

Colorectal cancer (CRC) mortality has declined in the past decade, especially among young patients.
In stage II/III patients, adjuvant chemotherapy within 3-6 months after surgery can improve their disease-free survival (DFS) and overall survival (OS).

For patients ≥70 years of age, adjuvant therapy can prolong the DFS of patients, and for patients >75 years of age, adjuvant chemotherapy can prolong the OS phase.
However, for elderly patients with CRC, the dose of chemotherapy is often reduced or discontinued.
A comprehensive geriatric assessment (CGA) can be used to predict the survival rate of cancer patients and the completion rate of chemotherapy.

Elderly patients are a heterogeneous population, ranging from healthy to infirm, with different comorbidities and the ability to tolerate chemotherapy.
Therefore, age itself should not be used as an exclusion criterion for adjuvant chemotherapy or palliative chemotherapy.

Screening flowchart for the GERICO study

The GERICO study is a randomized phase 3 clinical trial that included patients ≥70 years of age who received adjuvant chemotherapy for CRC or first-line palliative chemotherapy.
In this trial, vulnerable patients (patients with a G8 questionnaire ≤ 14 points) were randomly divided into a CGA-based intervention group or a standard care group at a ratio of 1:1, and were treated with guideline-based chemotherapy.
The main outcome of the trial was the completion of chemotherapy without reducing or delaying the dose of chemotherapy.
Secondary outcomes include chemotherapy toxicity, survival rate, and quality of life (QoL).

Relationship between patient's baseline characteristics and completion of planned chemotherapy

The results showed that of the 142 patients, 58% received adjuvant chemotherapy, and another 42% received first-line palliative chemotherapy.
Interventions include dressing changes (62%), nutritional therapy (51%), and physical therapy (39%).
Compared with the control group, more patients receiving intervention treatment completed planned chemotherapy (45% vs.
28%).
Severe drug toxicity occurred in 39% of the control group and 28% of the intervention group.
Compared with the control group, the quality of life and exercise ability of patients in the intervention group was improved, and the burden of disease was reduced.

All in all, the Phase 3 clinical trial revealed that compared with standard care, geriatric intervention can increase the number of vulnerable elderly patients with CRC who complete adjuvant chemotherapy, and can improve the disease burden and quality of life of patients.