Considerations and Challenges in the Management of the Older Patients with Gastric Cancer
Gastric cancer is one of the commonest malignancies with high rates of mortality worldwide. Older patients represent a substantial proportion of cases with this diagnosis. However, there are very few ‘elderly-specific’ trials in this setting. In addition, the inclusion rate of such patients in rando...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-03-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/6/1587 |
| _version_ | 1797472474972028928 |
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| author | Sotiris Loizides Demetris Papamichael |
| author_facet | Sotiris Loizides Demetris Papamichael |
| author_sort | Sotiris Loizides |
| collection | DOAJ |
| description | Gastric cancer is one of the commonest malignancies with high rates of mortality worldwide. Older patients represent a substantial proportion of cases with this diagnosis. However, there are very few ‘elderly-specific’ trials in this setting. In addition, the inclusion rate of such patients in randomised clinical trials is poor, presumably due to concerns about increased toxicity, co-existing comorbidities and impaired performance status. Therapeutic strategies for this patient group are therefore mostly based on retrospective subgroup analysis of randomised clinical trials. Review of currently available evidence suggests that older gastric cancer patients who are fit for trial inclusion may benefit from surgical intervention and peri-operative systemic chemotherapy strategies. For patients with metastatic disease, management has been revolutionized by the use of anti-HER2 directed therapies as well as immune checkpoint inhibitors with or without chemotherapy. Early data suggest that fit older patients may also benefit from these therapeutic interventions. However, once again there may be limitations in extrapolating these data to everyday clinical practice with older patients being less likely to have a good performance status and an intact immune system. Therefore, determining the functional age and not just the chronological age of a patient prior to initiating therapy becomes very important. The functional decline including reduced organ function that may occur in older patients makes the integration of some form of geriatric assessment in routine clinical practice very relevant. |
| first_indexed | 2024-03-09T20:03:17Z |
| format | Article |
| id | doaj.art-d4115747c4684263befccd7898558476 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T20:03:17Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-d4115747c4684263befccd78985584762023-11-24T00:41:08ZengMDPI AGCancers2072-66942022-03-01146158710.3390/cancers14061587Considerations and Challenges in the Management of the Older Patients with Gastric CancerSotiris Loizides0Demetris Papamichael1Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia 2006, CyprusDepartment of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia 2006, CyprusGastric cancer is one of the commonest malignancies with high rates of mortality worldwide. Older patients represent a substantial proportion of cases with this diagnosis. However, there are very few ‘elderly-specific’ trials in this setting. In addition, the inclusion rate of such patients in randomised clinical trials is poor, presumably due to concerns about increased toxicity, co-existing comorbidities and impaired performance status. Therapeutic strategies for this patient group are therefore mostly based on retrospective subgroup analysis of randomised clinical trials. Review of currently available evidence suggests that older gastric cancer patients who are fit for trial inclusion may benefit from surgical intervention and peri-operative systemic chemotherapy strategies. For patients with metastatic disease, management has been revolutionized by the use of anti-HER2 directed therapies as well as immune checkpoint inhibitors with or without chemotherapy. Early data suggest that fit older patients may also benefit from these therapeutic interventions. However, once again there may be limitations in extrapolating these data to everyday clinical practice with older patients being less likely to have a good performance status and an intact immune system. Therefore, determining the functional age and not just the chronological age of a patient prior to initiating therapy becomes very important. The functional decline including reduced organ function that may occur in older patients makes the integration of some form of geriatric assessment in routine clinical practice very relevant.https://www.mdpi.com/2072-6694/14/6/1587gastric cancerelderlyearly-stage diseaseadjuvantmetastatictargeted therapies |
| spellingShingle | Sotiris Loizides Demetris Papamichael Considerations and Challenges in the Management of the Older Patients with Gastric Cancer Cancers gastric cancer elderly early-stage disease adjuvant metastatic targeted therapies |
| title | Considerations and Challenges in the Management of the Older Patients with Gastric Cancer |
| title_full | Considerations and Challenges in the Management of the Older Patients with Gastric Cancer |
| title_fullStr | Considerations and Challenges in the Management of the Older Patients with Gastric Cancer |
| title_full_unstemmed | Considerations and Challenges in the Management of the Older Patients with Gastric Cancer |
| title_short | Considerations and Challenges in the Management of the Older Patients with Gastric Cancer |
| title_sort | considerations and challenges in the management of the older patients with gastric cancer |
| topic | gastric cancer elderly early-stage disease adjuvant metastatic targeted therapies |
| url | https://www.mdpi.com/2072-6694/14/6/1587 |
| work_keys_str_mv | AT sotirisloizides considerationsandchallengesinthemanagementoftheolderpatientswithgastriccancer AT demetrispapamichael considerationsandchallengesinthemanagementoftheolderpatientswithgastriccancer |