Recommendations NCCN, SIOG, SoFOG, etc.

Transcription

1 Recommendations NCCN, SIOG, SoFOG, etc. Etienne Brain, MD, PhD Medical Oncology HÔPITAL RENÉ HUGUENIN Au 1 er janvier 2010, le Centre René Huguenin devient l Hôpital René Huguenin, un établissement de soins, d enseignement et de recherche de l Institut Curie

2 Guidelines Meta-Analyses Trials Evolving consensus Saint-Gallen NIH NCCN GEPOG/SoFOG

3 SIOG 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: 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. BJU Int. 2010; 106:462-9 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: Treatment t of the elderly l colorectal l cancer patient: 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: Wildiers H, et al. Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol 2007;8: 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): 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 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: Body JJ, Coleman R, Clezardin P et al. International ti 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 U. Elderly patients have become the leading drug 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: , 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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5 G1 = fit No abnomaly CIRSG grade 2 (I)ADL normal MNA normal Standard treatment G2 vulnérable (reversible) CIRSG 1 grade 3 1 IADL Risk for denutrition 17 MNA < 24 Standard treatment ± geriatric intervention G3 fragile (non reversible) CIRSG 2 grade 3 or G4 1 grade 4 1ADL Severe denutrition MNA < 17 Cognitive impairement 15 < MMSE 24 Desorientation, confusion Symptomatic treatment ± specific actions Dependance, dementia Major comorbidities Terminal Palliative treatment

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12 NCCN disease-specific Bladder Breast CNS CRC H&N Kidney MM NSCLC Prostate t

13 GEPOG/SoFOG Metastatic CRC Fit: local treatment for A taste of "CGA» liver M+ whenever Patient involvement possible with preop chemo; clinical trials Social measures + denutrition / comorbidities Intermediate: radiofrequency; evaluate potential resection w/ preop assessment; monochemo Fragile: symptomatic treatment

14 National French Recommendations for Chemotherapy Summary of previous recommendations Validated regimens 4 AC 6CMF Options: TC 4 TC > 4 AC Post hoc sub group analysis 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 14