Download SIOG 2011 ms6_brain

Recommendations
NCCN, SIOG, SoFOG, etc.
Etienne Brain,
Brain MD
MD, PhD
Medical Oncology
HÔPITAL RENÉ HUGUENIN
Au 1er jjanvier 2010, le Centre René Huguenin
g
devient l’Hôpital René Huguenin,
un établissement de soins, d’enseignement
et de recherche de l’Institut Curie
Guidelines
• Meta
Meta-Analyses
Analyses
• Trials
• Evolving consensus
– Saint-Gallen
– NIH
– NCCN
– GEPOG/SoFOG
SIOG
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Anthracycline cardiotoxicity in the elderly cancer patient: a
SIOG expert position paper. Aapro M, Bernard-Marty C,
Brain E, et al. Ann Oncol. 2011;22:257-67
Management of prostate cancer in older men:
recommendations of a working group of the International
Society of Geriatric Oncology: Droz JP, Balducci L, Bolla
M et al
M,
al. BJU Int
Int. 2010; 106:462
106:462-9
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EORTC Elderly Task Force and Lung Cancer Group and
International Society for Geriatric Oncology (SIOG) experts'
opinion for the treatment of non-small-cell lung cancer in
an elderly population. Pallis AG, Gridelli C, van Meerbeeck
JP, et al. Ann Oncol 2010;21:692-706
T t
Treatment
t off the
th elderly
ld l colorectal
l
t l cancer patient:
ti t SIOG
expert recommendations. Papamichael D, Audisio R,
Horiot JC, et al. Ann Oncol 2009;20:5-16
The medical treatment of metastatic renal cell cancer in the
elderly: Position paper of a SIOG Taskforce. Bellmunt J,
Négrier S, Escudier E, et al. Crit Rev Oncol Hematol
2009;69:64-72
PACE participants, Audisio RA et al. Shall we operate?
Preoperative assessment in elderly cancer patients
(PACE) can help. A SIOG surgical task force prospective
study. Crit Rev Oncol Hematol 2008;65:156-63
Wildiers H,, et al. Management
g
of breast cancer in elderlyy
individuals: recommendations of the International Society
of Geriatric Oncology. Lancet Oncol 2007;8:1101-15
Lichtman SM, Wildiers H, Chatelut E, et al. International
Society of Geriatric Oncology Chemotherapy Taskforce:
Evaluation of chemotherapy in older patients - An analysis
of the medical literature. J Clin Oncol 2007;25(May): 18321832
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Monfardini S, et al. Organization of the clinical activity of
Geriatric Oncology: Report of a SIOG (International Society
of Geriatric Oncology) task force. Crit Rev Oncol Hematol
62:62-73, 2007
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Launay-Vacher V, Chatelut E, et al. Renal insufficiency in
elderly cancer patients: International Society of Geriatric
Oncology clinical practice recommendations
Ann Oncol 2007;18:1314-21
B d JJ
Body
JJ, C
Coleman
l
R
R, Clezardin
Cl
di P ett al.
l IInternational
t
ti
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society of geriatric oncology (SIOG) clinical practice
recommendations for the use of bisphosphonates in elderly
patients. Eur J Cancer 2007;43:852-8
Lichtman SM, et al. International Society of Geriatric
Oncology (SIOG) recommendations for the adjustment of
dosing in elderly cancer patients with renal insufficiency.
Eur J Cancer 43:14-34, 2007
Surbone A, et al., on behalf of the SIOG Task Force on
Cultural Competence in the Elderly. The illness trajectory
of elderly cancer patients across cultures: SIOG position
paper. Ann Oncol 18:633-8, 2007
Extermann M, et al. Use of comprehensive geriatric
assessment in older cancer patients: Recommendations
from the task force on CGA of the International Society of
Geriatric Oncology . Crit Rev Oncol Hematol 55:241-52,
2005, 2007
Wedding
g U. Elderly
yp
patients have become the leading
g drug
g
consumers: it's high time to properly evaluate new drugs
within the real targeted population.
J Clin Oncol 24:62-3, 2006 (no abstract available)
Audisio RA et al. The surgical management of elderly
cancer patients: recommendations of the SIOG Surgical
Task Force. Eur J Cancer 40:926-389,
40:926 389, 2004.
Repetto L, et al. Use of growth factors in the elderly patient
with cancer: a report from the second International Society
for Geriatric Oncology (SIOG) 2001 meeting . Crit Rev
Oncol Hematol 45:123-8, 2003
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G1 = “fit”
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– No abnomaly
– CIRSG
– ≥ 1 ADL
– Severe denutrition
– (I)ADL normal
– MNA normal
– Standard treatment
G2 “vulnérable”
vulnérable (reversible)
– CIRSG
• MNA < 17
– Cognitive impairement
• 15 < MMSE  24
– Desorientation, confusion
– Symptomatic treatment ±
specific actions
• ≥ 1 grade 3
– ≥ 1 IADL
– Risk for denutrition
• 17 ≤ MNA < 24
– Standard treatment ± geriatric
intervention
– CIRSG
• ≥ 2 grade 3 or
• ≥ 1 grade 4
• g
grade ≤ 2
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G3 “fragile”
“f il ” (non reversible)
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G4
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Dependance, dementia
Major comorbidities
Terminal
Palliative treatment
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NCCN disease-specific
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Bladder
Breast
CNS
CRC
H&N
Kidney
MM
NSCLC
P t t
Prostate
GEPOG/SoFOG
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Metastatic CRC
A taste of "CGA »
Patient involvement
Social measures +
denutrition / comorbidities
• Fit: local treatment for
liver M+ whenever
possible with preop
chemo; clinical trials
• Intermediate:
radiofrequency; evaluate
potential resection w/
preop assessment;
monochemo
• Fragile: symptomatic
treatment
National French Recommendations for
Chemotherapy
 Summary of previous recommendations
Validated regimens
4
AC
 6 CMF
Options: TC
4
TC > 4 AC
– Post hoc sub g
group
p analysis
y in a randomized trial,, n ~ 80
 Sequential regimen
No data
 Reassuring data for safety profile of
TC
MC (liposomal doxorubicin)
grade B
grade C
 Systematically discuss primary prophylaxis w/ GCSF
expert agreement
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