Less chemotherapy effective for older patients with stomach cancer

For older patients with advanced stomach or oesophageal cancer, less chemotherapy might prove to be more effective with fewer side effects like diarrhoea and lethargy, a new study has revealed.

The study was presented at the ASCO Annual Meeting 2019.

Dr Peter Hall, a co-chief investigator from the Cancer Research UK Edinburgh Centre, said: "Increasingly we're realising it's not just age that affects how well someone can tolerate their treatment and we need to do more work to understand how other conditions or aspects of frailty might play a role."

The study involved 514 people with stomach or oesophageal cancer having an average age of 76, while the oldest patient was 96.

Patients went through a careful medical assessment and then went onto chemotherapy with just two drugs. They were then carefully monitored to see how well the cancer was controlled, whether they had symptoms and side-effects.

The findings indicated that medium and lower doses of chemotherapy worked as effective as the full-strength dose in controlling cancer.

But when the researchers looked at the overall effect of the treatment, including quality of life, they reported that it was the lowest dose treatment that came out best.

"These valuable results reduce fears that giving a lower dose chemotherapy regimen is inferior and could make a huge difference for patients with stomach or oesophageal cancer who can't tolerate intensive courses of treatment," said Professor Charles Swanton, chief clinician of Cancer Research UK.

"Older or frail patients are often not considered for new drug trials or standard of care therapy as they're less able to tolerate combination chemotherapy," he added.

Professor Matt Seymour, a co-chief investigator at the University of Leeds said: "Doctors often prescribe reduced doses of drugs, or sometimes no chemotherapy at all, based on their clinical experience, but until now there has been little hard evidence to help them in those decisions."

Seymour also added that "Our results provide that evidence, so doctors can confidently give people a lower dose of chemotherapy, sparing them side effects without worrying that it's compromising their chance of survival.