Comprehensive geriatric assessment and early treatment failure in nonagenarian patients with cancer, a retrospective monocentric study

Background: The incidence of cancer among patients aged over 90 is increasing, but this population is poorly described in literature. This underrepresentation complicates decision-making for cancer treatments, despite the contribution of comprehensive geriatric assessment (CGA). This study aimed to describe early failure of specific anti-cancer treatments in a population of nonagenarians treated in a Comprehensive Cancer Center after undergoing a CGA. Methods: This retrospective, monocentric cohort study included patients aged over 90 referred to an oncogeriatric team for CGA between 2019 and 2023, regardless of cancer type or planned treatment. The primary endpoint was the early treatment failure rate within 3 months of the initiation of treatment, defined as unplanned discontinuation, progression, or death. Results: 119 patients were included, with a median age of 91 years (range: 90–99 years), 53 % were men. The most common cancers were skin (30 %), head and neck (24 %), genito-urinary (12 %), and breast cancers (11 %). Most patients were independent for activities of daily living with a median ADL score of 6/6 and IADL score of 3/4. They had an average of 1.3 severe comorbidities. Half of them suffered from undernutrition. The geriatric oncology team recommended 53.8 % treatment modifications (94.5 % de-escalation). The most common treatments received were radiotherapy (27 %), surgery (18 %), hormonal therapy (10 %) and chemotherapy (9 %). A quarter of the patients received exclusive supportive care. Among patients receiving specific treatment, early failure occurred in 22.7 % (20/88). The 6-month survival probability from initiation of treatment was 69.2 % (95 % CI: 60.3 %, 76.8 %), varying significantly by treatment intent: 93.9 % (95 % CI: 80.4 %, 98.3 %) for curative treatments, 77.4 % (95 % CI: 64.5 %, 86.6 %) for palliative treatments, and 26.8 % (95 % CI: 14.3 %, 44.6 %) for exclusive supportive care. Conclusion: In this population of nonagenarians, who benefit from a CGA to identify and manage patient frailties, anti-cancer treatments were carried out with few early treatment failures.