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Clinical Frontiers in Geriatric Oncology
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Clinical Frontiers in Geriatric Oncology

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (10 July 2023) | Viewed by 14581

Special Issue Editor

Prof. Dr. Gerardo Rosati

E-Mail Website
Guest Editor
Medical Oncology Unit, Ospedale San Carlo, 85100 Potenza, Italy
Interests: biological agents; cancer treatment; chemotherapy; geriatric assessment; hormone therapy; immunotherapy; monoclonal antibodies; older patients

Special Issue Information

Dear Colleagues,

The number of older cancer patients will constitute a real emergency in the coming years, especially in Western countries. The causes of this phenomenon are partially due to the increasing age of the population and also due the incidence of tumors, which increases over the years. This will have dramatic economic and social consequences for patients' families and may even threaten the solvency of national health systems. However, older patients constitute an extremely heterogeneous population. Oncological therapies cannot therefore be generalized because biological and physiological age take on different characteristics in these patients, among other things that are not well represented in clinical trials.

The aim of this Special issue is to take stock of the most innovative therapies in the treatment of cancer and to verify their impact and sustainability in the geriatric age.

Prof. Dr. Gerardo Rosati
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • biological agents
  • cancer treatment
  • chemotherapy
  • geriatric assessment
  • hormone therapy
  • immunotherapy
  • monoclonal antibodies
  • older patients

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Published Papers (7 papers)

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Editorial

Jump to: Research, Review, Other

3 pages, 203 KiB  
Editorial
Learning to Care for the Older People: An Urgent Need in the Daily Practice of Oncologists
by Gerardo Rosati
J. Clin. Med. 2022, 11(11), 3149; https://doi.org/10.3390/jcm11113149 - 1 Jun 2022
Cited by 3 | Viewed by 1307
Abstract
Cancer is the most widespread and prominent health issue worldwide and its incidence is only exceeded by cardiovascular diseases [...] Full article
(This article belongs to the Special Issue Clinical Frontiers in Geriatric Oncology)

Research

Jump to: Editorial, Review, Other

8 pages, 1314 KiB  
Article
SUPeRO: A Multidimensional Approach to Prevent and Manage Oncological Frailty in a Radiation Oncology Unit
by Beatrice Di Capua, Marialuisa Iervolino, Alessandra Rocconi, Serena Bracci, Elisa Marconi, Loredana Dinapoli, Francesco Presta, Maria Antonietta Gambacorta, Luca Tagliaferri, Fabio Marazzi, Vincenzo Valentini and Giuseppe Ferdinando Colloca
J. Clin. Med. 2022, 11(22), 6768; https://doi.org/10.3390/jcm11226768 - 15 Nov 2022
Cited by 3 | Viewed by 1534
Abstract
Currently, the management of older cancer patients is directed by a personalized approach and, where possible, a tailor-made treatment. Based on our previous experiences and considering the opportunity of combining a geriatric department and a radiation-oncology department, we have developed a path that [...] Read more.
Currently, the management of older cancer patients is directed by a personalized approach and, where possible, a tailor-made treatment. Based on our previous experiences and considering the opportunity of combining a geriatric department and a radiation-oncology department, we have developed a path that follows the patient from the beginning of the treatment, taking into account the complications/late toxicities and the survivors. This study aimed to evaluate the impact of remodeling and restructuring some oncology, radiotherapy, and geriatrics services based on the primary evidence for managing older cancer patients. In 2020, Gemelli ART underwent 60,319 radiation-oncology treatments, admitted 943 patients in the radiation-oncology and supportive care ward, and treated and followed 15,268 patients in clinics. The average length of stay of the admitted patients was reduced from 20.6 days to 13.2 days. In 2021, 1196 patients were assessed for frailty, 847 were admitted for toxicity, and 349 patients were evaluated within the geriatric oncology and supportive care outpatient clinic, and it was found that 59.2% were fit, 31.6% were vulnerable, and 9.2% were frail. This experience has shown a reduction in hospitalizations and the average hospital stay of patients in the case of side effects, a high toxicity to treatments, and the possibility of treating patients with a high level of complexity. This approach should represent the future target of geriatric oncology with the global management of older or complex patients with cancer. Full article
(This article belongs to the Special Issue Clinical Frontiers in Geriatric Oncology)
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15 pages, 1510 KiB  
Article
The Prognostic Value of Pre-Treatment Circulating Biomarkers of Systemic Inflammation (CRP, dNLR, YKL-40, and IL-6) in Vulnerable Older Patients with Metastatic Colorectal Cancer Receiving Palliative Chemotherapy—The Randomized NORDIC9-Study
by Gabor Liposits, Halla Skuladottir, Jesper Ryg, Stine Brændegaard Winther, Sören Möller, Eva Hofsli, Carl-Henrik Shah, Laurids Østergaard Poulsen, Åke Berglund, Camilla Qvortrup, Pia Osterlund, Julia S. Johansen, Bengt Glimelius, Halfdan Sorbye and Per Pfeiffer
J. Clin. Med. 2022, 11(19), 5603; https://doi.org/10.3390/jcm11195603 - 23 Sep 2022
Cited by 9 | Viewed by 2134
Abstract
Appropriate patient selection for palliative chemotherapy is crucial in patients with metastatic colorectal cancer (mCRC). We investigated the prognostic value of C-reactive protein (CRP), derived neutrophil-to-lymphocyte ratio (dNLR), Interleukin (IL)-6, and YKL-40 on progression-free survival (PFS) and overall survival (OS) in the NORDIC9 [...] Read more.
Appropriate patient selection for palliative chemotherapy is crucial in patients with metastatic colorectal cancer (mCRC). We investigated the prognostic value of C-reactive protein (CRP), derived neutrophil-to-lymphocyte ratio (dNLR), Interleukin (IL)-6, and YKL-40 on progression-free survival (PFS) and overall survival (OS) in the NORDIC9 cohort. The randomized NORDIC9-study included patients ≥70 years with mCRC not candidates for standard full-dose combination chemotherapy. Participants received either full-dose S1 (Teysuno) or a dose-reduced S1 plus oxaliplatin. Blood samples were collected at baseline and biomarkers were dichotomized according to standard cut-offs. Multivariable analyses adjusted for age, sex, ECOG performance status, and treatment allocation; furthermore, C-statistics were estimated. In total, 160 patients with a median age of 78 years (IQR: 76–81) were included between 2015 and 2017. All investigated biomarkers were significantly elevated in patients with either weight loss, ≥3 metastatic sites, or primary tumor in situ. In multivariable analyses, all markers showed significant association with OS; the highest HR was observed for CRP (HR = 3.40, 95%CI: 2.20–5.26, p < 0.001). Regarding PFS, statistically significant differences were found for CRP and IL-6, but not for dNLR and YKL-40. Applying C-statistics, CRP indicated a good prognostic model for OS (AUC = 0.72, 95%CI: 0.67–0.76). CRP is an easily available biomarker, which may support therapeutic decision-making in vulnerable older patients with mCRC. Full article
(This article belongs to the Special Issue Clinical Frontiers in Geriatric Oncology)
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11 pages, 1764 KiB  
Article
Inflammatory Indexes as Prognostic Factors of Survival in Geriatric Patients with Hepatocellular Carcinoma: A Case Control Study of Eight Slovak Centers
by Dominik Safcak, Sylvia Drazilova, Jakub Gazda, Igor Andrasina, Svetlana Adamcova-Selcanova, Lea Balazova, Radovan Barila, Michal Mego, Marek Rac, Lubomir Skladany, Miroslav Zigrai, Martin Janicko and Peter Jarcuska
J. Clin. Med. 2022, 11(14), 4183; https://doi.org/10.3390/jcm11144183 - 19 Jul 2022
Cited by 2 | Viewed by 1442
Abstract
Background and Aims: Hepatocellular cancer (HCC) often occurs in geriatric patients. The aim of our study was to compare overall survival and progression-free survival between geriatric patients (>75 years) and patients younger than 75 years and to identify predictive factors of survival in [...] Read more.
Background and Aims: Hepatocellular cancer (HCC) often occurs in geriatric patients. The aim of our study was to compare overall survival and progression-free survival between geriatric patients (>75 years) and patients younger than 75 years and to identify predictive factors of survival in geriatric patients with HCC. Material and Methods: We performed a retrospective analysis of patients with HCC diagnosed in Slovakia between 2010–2016. Cases (HCC patients ≥75 years) were matched to controls (HCC patients <74 years) based on the propensity score (gender, BCLC stage and the first-line treatment). Results: We included 148 patients (84 men, 57%) with HCC. There were no differences between cases and controls in the baseline characteristics. The overall survival in geriatric patients with HCC was comparable to younger controls (p = 0.42). The one-, two-, and three-year overall survival was 42% and 31%, 19% and 12%, and 12% and 9% in geriatric patients and controls, respectively (p = 0.2, 0.4, 0.8). Similarly, there was no difference in the one- and two-year progression-free survival: 28% and 18% vs. 10% and 7% in geriatric HCC patients and controls, respectively (p = 0.2, 1, -). There was no case–control difference between geriatric HCC patients and younger HCC controls in the overall survival in the subpopulation of patients with no known comorbidities (p = 0.5), one and two comorbidities (p = 0.49), and three or more comorbidities (p = 0.39). Log (CRP), log (NLR), log (PLR), and log (SII) were all associated with the three-year survival in geriatric HCC patients in simple logistic regression analyses. However, this time, only log (NLR) remained associated even after controlling for the age and BCLC confounding (OR 5.32, 95% CI 1.43–28.85). Conclusions. We found no differences in overall survival and progression-free survival between older and younger HCC patients. Parameters of subclinical inflammation predict prognosis in geriatric patients with HCC. A limitation of the study is small number of the treated patients; therefore, further investigation is warranted. Full article
(This article belongs to the Special Issue Clinical Frontiers in Geriatric Oncology)
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12 pages, 502 KiB  
Article
The Latest Data Specifically Focused on Long-Term Oncologic Prognostication for Very Old Adults with Acute Vulnerable Localized Prostate Cancer: A Nationwide Cohort Study
by Szu-Yuan Wu, Fransisca Fortunata Effendi, Ricardo E. Canales and Chung-Chien Huang
J. Clin. Med. 2022, 11(12), 3451; https://doi.org/10.3390/jcm11123451 - 15 Jun 2022
Cited by 3 | Viewed by 1968
Abstract
Purpose: Few studies have evaluated the prime treatment choice for men older than 80 years with acute vulnerable localized prostate cancer (AV-LPC). Clinicians have been deeply troubled by this near end-of-life medical choice for a very specific group of patients. We compared the [...] Read more.
Purpose: Few studies have evaluated the prime treatment choice for men older than 80 years with acute vulnerable localized prostate cancer (AV-LPC). Clinicians have been deeply troubled by this near end-of-life medical choice for a very specific group of patients. We compared the oncological prognostication of very old patients with AV-LPC after they underwent either radical prostatectomy (RP) or massive-dose intensity-modulated radiotherapy (IMRT) coupled with long-term androgen deprivation therapy (ADT) over a long-term investigation. Methods: In this nationwide cohort study, we used the Taiwan Cancer Registry Database and retrieved information related to patients (aged ≥ 80 years) with AV-LPC who underwent standard RP (the RP group) or massive-dose IMRT + long-term ADT (at least 72 Gy and ADT use ≥18 months; the IMRT + ADT group). After potential confounders were controlled for using propensity score matching (PSM), we utilized the Cox proportional hazards regression to evaluate the oncologic prognostication. Results: The IMRT + ADT group had a significantly higher adjusted hazard ratio (aHR) for all-cause mortality (aHR, 2.00; 95% confidence interval [CI], 1.41–2.87) than the RP group. Analysis of the secondary outcomes revealed that compared with the RP group, the aHRs of biochemical failure, locoregional recurrence, and distant metastasis in the IMRT + ADT group were 1.77 (95% CI: 1.36–2.11, p < 0.0001), 1.12 (95% CI: 1.04–1.33, p < 0.0001), and 1.15 (95% CI: 1.06–1.71, p = 0.0311), respectively. Conclusion: RP provides more favorable oncological prognostication than IMRT in very old adults with AV-LPC. Full article
(This article belongs to the Special Issue Clinical Frontiers in Geriatric Oncology)
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Review

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42 pages, 875 KiB  
Review
Immunotherapy in Elderly Patients Affected by Non-Small Cell Lung Cancer: A Narrative Review
by Michele Montrone, Gerardo Rosati, Vito Longo, Annamaria Catino, Raffaella Massafra, Annalisa Nardone, Francesco Pesola, Elisabetta Sara Montagna, Ilaria Marech, Pamela Pizzutilo and Domenico Galetta
J. Clin. Med. 2023, 12(5), 1833; https://doi.org/10.3390/jcm12051833 - 24 Feb 2023
Cited by 7 | Viewed by 3855
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide. Non-small cell lung cancer (NSCLC) accounts for approximately 80% of all lung cancers, and most NSCLC is diagnosed in the advanced stage. The advent of immune check point inhibitors (ICIs) changed the therapeutic [...] Read more.
Lung cancer is the leading cause of cancer-related deaths worldwide. Non-small cell lung cancer (NSCLC) accounts for approximately 80% of all lung cancers, and most NSCLC is diagnosed in the advanced stage. The advent of immune check point inhibitors (ICIs) changed the therapeutic scenario both in metastatic disease (in first and subsequent lines) and earlier settings. Comorbidities, reduced organ function, cognitive deterioration, and social impairment give reasons for a greater probability of adverse events, making the treatment of elderly patients challenging. The reduced toxicity of ICIs compared to standard chemotherapy makes this approach attractive in this population. The effectiveness of ICIs varies according to age, and patients older than 75 years may benefit less than younger patients. This may be related to the so-called immunosenescence, a phenomenon that refers to the reduced activity of immunity with older age. Elders are often under-represented in clinical trials, even if they are a large part of the patients in a clinical practice. In this review, we aim to explore the biological aspects of immunosenescence and to report and analyze the most relevant and recent literature findings on the role of immunotherapy in elderly patients with NSCLC. Full article
(This article belongs to the Special Issue Clinical Frontiers in Geriatric Oncology)
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Other

9 pages, 792 KiB  
Brief Report
Geriatric Assessment Implementation before Chemotherapy in MEtastatic Prostate Cancer, Results from the Real-Life Study GAMERS
by Cassandre Gluszak, Loïc Campion, Valérie Seegers, Oana Cojocarasu, Jean-Marie Commer, Frank Priou, Frédéric Rolland, Catherine Terret and Sophie Abadie-Lacourtoisie
J. Clin. Med. 2023, 12(4), 1636; https://doi.org/10.3390/jcm12041636 - 18 Feb 2023
Cited by 3 | Viewed by 1440
Abstract
Geriatric assessment (GA) can predict and improve treatment tolerance and estimate overall survival in older patients with cancer. Several international organizations promote GA; however, data related to its implementation in daily clinical practice are still limited. We aimed to describe GA implementation in [...] Read more.
Geriatric assessment (GA) can predict and improve treatment tolerance and estimate overall survival in older patients with cancer. Several international organizations promote GA; however, data related to its implementation in daily clinical practice are still limited. We aimed to describe GA implementation in patients over 75 years old with metastatic prostate cancer treated with docetaxel as first-line treatment, and with positive G8 screening test or frailty criteria. This retrospective real-world study included 224 patients treated from 2014 to 2021 in four French centers, including 131 patients with a theoretical indication of GA. Among the latter, 51 (38.9%) patients had GA. The main barriers to GA were the lack of systematic screening (32/80, 40.0%), unavailability of geriatric physician (20/80, 25.0%), and absence of referral despite a positive screening test (12/80, 15.0%). With GA performed in only one-third of the patients with a theoretical indication in daily clinical practice, mostly due to an absence of screening test, the use of GA is currently sub-optimal. Full article
(This article belongs to the Special Issue Clinical Frontiers in Geriatric Oncology)
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