Upfront reduced-dose regimens tested head-to-head in frail older patients
Frail older patients are often given full doses and then have them cut after bad side effects, or are given nothing. Trials should test starting at a lower dose from the beginning.
The GO2 trial in frail patients with advanced gastro-oesophageal cancer showed that the lowest of three chemotherapy dose levels gave non-inferior progression-free survival with better patient experience. This design, comparing upfront dose levels rather than escalating after toxicity, is rarely used elsewhere. A programme of GO2-style trials across common cancers would give evidence for the many frail patients for whom current guidelines offer only extrapolation.
- Older and multimorbid patients are excluded and undertreated · Most people with cancer are over 65 but most trial patients are younger and fitter. We guess how to treat the majority.
- Wrong doses · Most drug doses were chosen as the highest a person can tolerate, which is often more than they need.
- Trial design, endpoints and cost · A phase 3 trial takes years and hundreds of millions of dollars, and often answers a question that has already moved on.
Pages like this
not linked directly; found by shared links- IdeaDose-finding in older and frail patients, not extrapolation from fit ones
Shares GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth, Older and multimorbid patients are excluded and undertreated, Wrong doses, Cytotoxic chemotherapy.
- IdeaTest DPYD, UGT1A1 and TPMT/NUDT15 before the first dose, everywhere
Shares Wrong doses, Cytotoxic chemotherapy, Gastric & gastro-oesophageal junction cancer, Colorectal cancer.
- IdeaDedicated cohorts for patients with performance status 2 in first-line trials
Shares Older and multimorbid patients are excluded and undertreated, Oesophageal cancer, Gastric & gastro-oesophageal junction cancer.
- IdeaGeriatric assessment by default for every older patient, and trials that admit them
Shares GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth, Older and multimorbid patients are excluded and undertreated.
- IdeaGeriatric assessment by default for every patient over 70 starting cancer treatment
Shares GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth, Older and multimorbid patients are excluded and undertreated.
- PersonDavid Cunningham
Shares Oesophageal cancer, Gastric & gastro-oesophageal junction cancer, Colorectal cancer.
- IdeaA mandatory over-70s cohort with geriatric assessment in every pivotal trial
Shares Older and multimorbid patients are excluded and undertreated, Wrong doses.
- IdeaHome administration of selected chemotherapy and immunotherapy for older and frail patients
Shares Older and multimorbid patients are excluded and undertreated, Cytotoxic chemotherapy.