改良CARG模型指导抗癌药物剂量调整对老年肿瘤患者不良反应的影响

doi:10.16352/j.issn.1001-6325.2025.10.1277

基础医学与临床 ›› 2025, Vol. 45 ›› Issue (10): 1277-1283.doi: 10.16352/j.issn.1001-6325.2025.10.1277

• 特邀专题:老年肿瘤患者的治疗 • 上一篇下一篇

改良CARG模型指导抗癌药物剂量调整对老年肿瘤患者不良反应的影响

葛郁平¹, 华雨薇¹, 王利娜², 侯秀凤¹, 宋华¹, 郭欣颖¹, 张媛¹, 王雅楠¹, 管梅^1*

1.中国医学科学院北京协和医学院北京协和医院肿瘤内科,北京 100730;
2.北京朝阳中西医结合急诊抢救医院肿瘤科三区,北京 100021

收稿日期:2025-03-10 修回日期:2025-06-27 出版日期:2025-10-05 发布日期:2025-09-22
通讯作者: ^*guanmei@pumch.cn
基金资助:
中央高水平医院临床研究专项(2022-PUMCH-B-049)

Impact of a modified CARG model guiding anticancer drug dose adjustments on adverse events in elderly cancer patients

GE Yuping¹, HUA Yuwei¹, WANG Lina², HOU Xiufeng¹, SONG Hua¹, GUO Xinying¹, ZHANG Yuan¹, WANG Yanan¹, GUAN Mei^1*

1. Department of Medical Oncology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730;
2. Department of Oncology Ward 3, Beijing Chaoyang Integrative Medicine Rescue and First Aid Hospital, Beijing 100021, China

Received:2025-03-10 Revised:2025-06-27 Online:2025-10-05 Published:2025-09-22
Contact: ^*guanmei@pumch.cn

摘要/Abstract

摘要： 目的探索应用改良CARG模型指导中国老年肿瘤患者抗癌药物剂量调整。方法前瞻性收集北京协和医院肿瘤内科2022年9月1日至2023年10月29日收治的年龄≥65岁的实体肿瘤患者的临床资料,对其进行老年综合评估(CGA)和CARG评分,根据CARG评分分为低、中、高风险组,结合治疗目的(根治性、姑息性)给予相应比例的抗癌药物减量,记录所有患者的抗癌(化疗、靶向和免疫治疗)生存数据和不良反应。采用费舍尔精确检验对比CARG评分指导调整剂量组(试验组)和医生经验性调整剂量组(对照组)不良反应发生率的关系。采用受试者操作特征曲线(ROC)分析CARG模型对抗癌药物严重不良反应的预测价值。结果共纳入166例年龄≥65岁老年实体肿瘤患者,中位年龄71岁(65~90岁),78.3%为男性,68.7%为消化道肿瘤,69.3%为Ⅳ期。试验组95例,其中CARG评分低、中、高风险组人数分别为24例(25.3%)、51例(53.7%)和20例(21.0%),对照组71例。随访截止于2024年12月31日,81例患者疾病进展,10例死亡。试验组和对照组的总体不良反应发生率分别为92.6%和94.4%,其中≥3级不良反应发生率分别为45.3%和43.7%,两组之间均无显著统计学差异。结论改良CARG模型指导剂量调整策略达到了与经验性剂量调整相当的安全性,符合老年肿瘤患者的个体化治疗理念,优化了老年肿瘤治疗的决策工具。

关键词: 老年肿瘤患者, CARG模型, 化疗剂量调整, 不良反应

Abstract: Objective To evaluate the clinical value of a modified Cancer and Aging Research Group(CARG) model in guiding anticancer drug dose adjustments for elderly cancer patients in China. Methods This prospective study enrolled patients aged ≥65 years with solid tumors at the Department of Oncology, Peking Union Medical College Hospital from September 1, 2022 to October 29, 2023. All patients underwent comprehensive geriatric assessment(CGA) and CARG risk scoring, and were stratified into low-, intermediate-, and high-risk groups. Anticancer drug doses(including chemotherapy, targeted therapy or immunotherapy) were reduced proportionally based on CARG risk stratification and treatment intent(curative vs. palliative). Treatment outcomes and adverse events(AEs) were recorded regularly. Fisher's Exact Test compared AE incidence between the CARG-guided dose adjustment group(experimental) and the physician-experience-guided dose adjustment group(control). Receiver operating characteristic(ROC) curve analysis was used to assess the predictive value of the CARG model for severe toxicity. Results Among 166 enrolled patients(median age: 71 years[range: 65-90]; 78.3% were male; 68.7% had gastrointestinal cancers; 69.3% had stage Ⅳ), 95 were assigned to the experimental group(CARG low-risk: 24[25.3%], intermediate-risk: 51 [53.7%], high-risk: 20[21.0%]) and 71 were included into the control group. By December 31, 2024, 81 patients experienced disease progression and 10 patients died. Overall AE rates was 92.6% in the experimental group and 94.4% in the control group, while grade ≥3 AEs were recorded in 45.3% vs. 43.7%, respectively(both P＞0.05). Conclusions The modified CARG model-guided dose adjustment strategy achieved comparable safety to empirical dose adjustment, which is in line with the individualized treatment paradigm for elderly cancer patients, representing a structured framework for optimizing therapeutic decision-making in geriatric oncology.

Key words: elderly cancer patients, CARG model, dose adjustments of anticancer drugs, adverse events

中图分类号:

葛郁平, 华雨薇, 王利娜, 侯秀凤, 宋华, 郭欣颖, 张媛, 王雅楠, 管梅. 改良CARG模型指导抗癌药物剂量调整对老年肿瘤患者不良反应的影响[J]. 基础医学与临床, 2025, 45(10): 1277-1283.

GE Yuping, HUA Yuwei, WANG Lina, HOU Xiufeng, SONG Hua, GUO Xinying, ZHANG Yuan, WANG Yanan, GUAN Mei. Impact of a modified CARG model guiding anticancer drug dose adjustments on adverse events in elderly cancer patients[J]. Basic & Clinical Medicine, 2025, 45(10): 1277-1283.

参考文献

[1] Lichtman SM. Therapy insight: Therapeutic challenges in the treatment of elderly cancer patients[J]. Nat Clin Pract Oncol, 2006, 3: 86-93.
[2] Rodin MB, Mohile SG. A practical approach to geriatric assessment in oncology[J]. J Clin Oncol, 2007, 25: 1936-1944.
[3] Schrijvers D, Highley M, De Bruyn E, et al. Role of red blood cells in pharmacokinetics of chemotherapeutic agents[J]. Anticancer Drugs, 1999, 10: 147-153.
[4] Extermann M, Boler I, Reich RR, et al. Predicting the risk of chemotherapy toxicity in older patients: the chemotherapy risk assessment scale for high-age patients(CRASH) score[J]. Cancer, 2012, 118: 3377-3386.
[5] Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study[J]. J Clin Oncol, 2011, 29: 3457-3465.
[6] Hurria A, Mohile S, Gajra A, et al. Validation of a prediction tool for chemotherapy toxicity in older adults with cancer[J]. J Clin Oncol, 2016, 34: 2366-2371.
[7] Magnuson A, Sedrak MS, Gross CP, et al. Development and validation of a risk tool for predicting severe toxicity in older adults receiving chemotherapy for early-stage breast cancer[J]. J Clin Oncol, 2021, 39: 608-618.
[8] Versteeg KS, Looijaard S, Slee-Valentijn MS, et al. Predicting outcome in older patients with cancer: comprehensive geriatric assessment and clinical judgment[J]. J Geriatr Oncol, 2021, 12: 49-56.
[9] Baxter MA, Rowe M, Zucker K, et al. UK national observational cohort study investigating tolerance of anti-cancer systemic therapy in the elderly: the TOASTIE study[J]. BMJ Oncol, 2024, 3: e000459.doi: 10.1136/bmjonc-2024-000459.
[10] Anwar MR, Yeretzian ST, Ayala AP, et al. Effectiveness of geriatric assessment and management in older cancer patients: a systematic review and meta-analysis[J]. J Natl Cancer Inst, 2023, 115: 1483-1496.
[11] Disalvo D, Moth E, Soo WK, et al. The effect of comprehensive geriatric assessment on care received, treatment completion, toxicity, cancer-related and geriatric assessment outcomes, and quality of life for older adults receiving systemic anti-cancer treatment: a systematic review[J]. J Geriatr Oncol, 2023, 14: 101585.doi: 10.1016/j.jgo.2023.101585.
[12] Chuang MH, Chen JY, Tsai WW, et al. Impact of comprehensive geriatric assessment on the risk of adverse events in the older patients receiving anti-cancer therapy: a systematic review and meta-analysis[J]. Age Ageing, 2022, 51: afac145. doi: 10.1093/ageing/afac145.
[13] Alibhai SMH, Breunis H, Hansen AR, et al. Examining the ability of the cancer and aging research group tool to predict toxicity in older men receiving chemotherapy or androgen-receptor-targeted therapy for metastatic castration-resistant prostate cancer[J]. Cancer, 2021, 127: 2587-2594.
[14] Jayani RV, Magnuson AM, Sun CL, et al. Association between a cognitive screening test and severe chemo-therapy toxicity in older adults with cancer[J]. J Geriatr Oncol, 2020, 11: 284-289.
[15] Mohamed MR, Loh KP, Mohile SG, et al. External validation of risk factors for unplanned hospitalization in older adults with advanced cancer receiving chemotherapy[J]. J Natl Compr Canc Netw, 2023, 21: 273-280.e3.
[16] Pang A, Jiali L, Ng A, et al. Use of the cancer and aging research group predictive model for chemotherapy-related toxic effects in a multiethnic, older adult Asian population[J]. JAMA Netw Open, 2022, 5: e2237196.
[17] Wildiers H, Heeren P, Puts M, et al. International society of geriatric oncology consensus on geriatric assessment in older patients with cancer[J]. J Clin Oncol, 2014, 32: 2595-2603.
[18] Wildes TM, Maggiore RJ, Tew WP, et al. Factors associated with falls in older adults with cancer: a validated model from the cancer and aging research group[J]. Support Care Cancer, 2018, 26: 3563-3570.
[19] Elias R, Loh KP, Targia V, et al. Behavioral, psychological, and supportive care interventions in geriatric oncology: the cancer and aging research group infrastructure core[J]. J Geriatr Oncol, 2020, 11: 347-349.
[20] Goh WY, Neo HY, Teo HL, et al. Protocol for a randomised controlled trial on impact of comprehensive geriatric and supportive assessment versus standard care in older adults with cancer undergoing curative treatment: the geriatric oncology SuPportive clinic for elderly(GOSPEL) study[J]. J Geriatr Oncol, 2023, 14: 101342.doi: 10.1016/j.jgo.2022.07.002.

改良CARG模型指导抗癌药物剂量调整对老年肿瘤患者不良反应的影响

Impact of a modified CARG model guiding anticancer drug dose adjustments on adverse events in elderly cancer patients

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