Approaches to cancer treatment in the elderly: Gastric cancer

Abstract

A standard form of chemotherapy for elderly patients with gastric cancer has yet to be established. The factors for this can be grouped into 3 categories: (1) elderly subjects have been excluded from major phase III trials in Japan, (2) there are few clinical studies targeting only for the elderly, and randomized trials have not conducted only for the elderly, and (3) the elderly are a diverse population, so using a uniform therapy to treat the elderly as a whole is not feasible. Over the past few years, the concept of assessing the diversity of elderly patients beforehand and then selecting an appropriate treatment has gained ground, but there is insufficient evidence substantiating the validity of that concept. In the area of gastric cancer, a randomized trial focusing on a form of geriatric assessment is underway to deal with the 3 categories of factors mentioned earlier. S‐1 therapy is readily used to treat cancer in elderly patients, but SOX (S‐1+L‐OHP) therapy would presumably have greater efficacy than therapy with S‐1 alone. Thus, the primary objective of the current trial was to compare S‐1 monotherapy and SOX (S‐1+L‐OHP) therapy using the the G8 and the Charlson Comorbidity Index for geriatric assessment. The secondary objective of this trial was to create a dataset of elderly patients with gastric cancer undergoing chemotherapy along with accompanying prospective clinical information and geriatric assessments. A potential secondary use of this dataset would be to establish an adverse event scoring system. This trial is being conducted by a Japan Agency for Medical Research and Development (AMED) research group with public funding. This presentation at this workshop will describe approaches that have been taken in the area of gastric cancer before the aforementioned trial was devised.