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

doi:10.16352/j.issn.1001-6325.2025.10.1277

Abstract

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

CLC Number:

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.

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