Predictors of poor treatment tolerability in older patients receiving fluoropyrimidine-based chemotherapy: A prospective cohort study
Year: 2026
Type: article
Abstract: INTRODUCTION: Although fluoropyrimidines are widely prescribed to older patients, studies investigating predictors for chemotherapy intolerance in this patient population are scarce. Therefore, we aimed to identify predictors of poor treatment tolerability in older patients receiving fluoropyrimidine-based chemotherapy. MATERIALS AND METHODS: Patients aged ≥70 years who received fluoropyrimidine-based chemotherapy were selected from the prospective, multicentre, non-randomized Alpe2U study. Before treatment initiation, participants underwent a geriatric assessment investigating the somatic, nutritional, functional, and mental domains. Predictors of the composite endpoint "poor treatment tolerability," defined as either Common Toxicity Criteria Adverse Events (CTCAE) grade 3-5 chemotherapy-related toxicity, dose reduction, or treatment discontinuation within the first two cycles, were analysed using uni- and multivariable logistic regression models. RESULTS: Of the 194 included patients, median age was 75 (interquartile range 73-79) years and the most common tumour types were colorectal (60%) and esophagogastric (19%) cancer. Most patients (89%) received capecitabine-based chemotherapy. Poor treatment tolerability within the first two cycles was seen in 31% of patients. In multivariable analyses, associations with poor treatment tolerability were found for deficits in 3-4 geriatric domains compared with 0 deficits (odds ratio [OR] 4.03, 95% confidence interval [CI] 1.09-14.97, p = 0.04) and for combination chemotherapy (OR 2.83, 95% CI 1.31-6.09, p = 0.008). DISCUSSION: Having deficits in multiple geriatric domains and combination chemotherapy were predictors of poor treatment tolerability within the first two cycles in older patients treated with fluoropyrimidine-based chemotherapy. These findings highlight the importance of a geriatric assessment before fluoropyrimidine administration to estimate risk of treatment intolerance.
Source: Journal of Geriatric Oncology
Authors: Joosje C. Baltussen, Jonathan E. Knikman, Nienke A. de Glas, Mirjam de With, Arnold Baars, Geert-Jan Creemers, Helga J. Droogendijk, Edward Fiets, Liselot van Iersel-Valkenburg, Caroline M.P.W. Mandigers, Alexander L.T. Imholz, Marlene H.W. van de Poel, Frank J.F. Jeurissen, Machteld Wymenga, Peter Nieboer, Tessa Tigges, Eeke Wesseling, Jan H.M. Schellens, Jesse J. Swen, Henk-Jan Guchelaar, Ron H.J. Mathijssen, Hans Gelderblom, Simon P. Mooijaart, Annemieke Cats, Johanneke E.A. Portielje
Institutions: Leiden University Medical Center, The Netherlands Cancer Institute, Helse Førde, Erasmus MC, Erasmus MC Cancer Institute, Ziekenhuis Gelderse Vallei, Catharina Ziekenhuis, Bravis Ziekenhuis, Medisch Centrum Leeuwarden, Maastricht University Medical Centre, Canisius-Wilhelmina Ziekenhuis, Deventer Ziekenhuis, Laurentius Ziekenhuis, Medisch Centrum Haaglanden, Stichting Haaglanden Medisch Centrum, Medisch Spectrum Twente, Utrecht University, Leiden University
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,610
Funder: KWF Kankerbestrijding
Award: G5310639713
OpenAlex ID: W7148502620