human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Development of a geriatric screening tool is necessary to identify elderly cancer patients who would benefit from comprehensive geriatric assessment ( CGA ) .  We develop and evaluate the G-8 screening tool against various reference tests . PATIENTS AND METHODS Analyses were based on 364 cancer patients aged>70 years scheduled to receive first-line chemotherapy included in a multicenter prospect i ve study . The G-8 consists of seven items from the Mini Nutritional Assessment ( MNA ) question naire and age . Our primary reference test is based on a set of seven CGA scales : Activities Daily Living ( ADL ) , Instrumental ADL , MNA , Mini-Mental State Exam , Geriatric Depression Scale , Cumulative Illness Rating Scale-Geriatrics , and Timed Get Up and Go . We considered the presence of at least one question naire with an impaired score as an abnormal reference exam . Additional reference exams are also discussed . RESULTS The prevalence of being at risk varied from 60 % to 94 % according to the various definitions of the reference test . When considering the primary reference test , a cut-off value of 14 for the G-8 tool provided a good sensitivity estimate ( 85 % ) without deteriorating the specificity excessively ( 65 % ) . CONCLUSION The G-8 shows good screening properties for identifying elderly cancer patients who could benefit from CGA Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies , posing the dilemma of whether to intensify therapy , thereby improving the cure rate , or de-escalate therapy , thereby reducing toxicity , with consequent risks for under- or overtreatment . Adequate tools to define doses and combinations have not been identified for lymphoma patients . We conducted a prospect i ve trial aim ed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment ( CGA ) in elderly ( aged ≥70 years ) patients with diffuse large B-cell lymphoma ( DLBCL ) . In June 2000 to March 2006 , 100 patients were stratified using a CGA into three groups ( fit , unfit , and frail ) , and they received a rituximab plus cyclophosphamide , doxorubicin , vincristine , and prednisone modulated in dose and drugs according to comorbidities and activities of daily living ( ADL ) and instrumental ADL scores . Treatment was associated with a complete response rate of 81 % and mild toxicity : grade 4 neutropenia in 14 % , anemia in 1 % , and neurological and cardiac toxicity in 2 % of patients . At a median follow-up of 64 months , 51 patients were alive , with 5-year disease-free , overall , and cause-specific survival rates of 80 % , 60 % , and 74 % , respectively . Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL . Wide use of this CGA-driven treatment may result in better cure rates , especially in fit and unfit patients Background : Elderly cancer patients form a heterogeneous population in which therapeutic decision-making is often difficult . The aim of this r and omised phase II trial was to evaluate the feasibility and activity of weekly docetaxel/gemcitabine ( DG ) followed by erlotinib after progression ( arm A ) vs erlotinib followed by DG after progression ( arm B ) in fit elderly patients with advanced non small-cell lung cancer ( NSCLC ) . Methods : Elderly chemotherapy-naive patients with stage IIIB/IV NSCLC were selected after a comprehensive geriatric assessment ( socioeconomic , cognitive , depression , ADL and IADL assessment s ) . The primary endpoint was the time to second progression ( TTP2 ) . Overall survival ( OS ) , the time to first progression ( TTP1 ) and safety were secondary endpoints . Results : Between July 2006 and November 2008 , 22 centres enrolled 100 patients .  TTP2 was 7.5 and 5.8 months in arm A and arm B , respectively ; TTP1 was 4.7 and 2.7 months ; and the median OS time was 9.4 and 7.1 months ; the respective 1-year survival rates were 36.2 and 31.4 % . There was no major unexpected toxicity . Conclusion : These results suggest that weekly DG , followed by erlotinib , is a promising treatment for fit elderly patients with NSCLC ; the efficacy of the reverse sequence was insufficient to recommend it for EGFR-non-selected patients BACKGROUND Elderly patients with advanced non-small-cell lung cancer ( NSCLC ) may derive similar benefit from platinum-based chemotherapy as younger patients .  Quality of life ( QoL ) and comprehensive geriatric assessment ( CGA ) is often advocated to assess benefits and risks . PATIENTS AND METHODS A total of 181 chemotherapy-naive patients [ ≥70 years , performance score ( PS ) of 0 - 2 ] with stage III-IV NSCLC received carboplatin and gemcitabine ( CG ) ( n = 90 ) or carboplatin and paclitaxel ( CP ) ( n = 91 ) every 3 weeks for up to four cycles . Primary end point was change in global QoL from baseline compared with week 18 . Pretreatment CGA and mini geriatric assessment during and after treatment were undertaken . A principal component ( PC ) analysis was carried out to determine the underlying dimensions of CGA and QoL and subsequently related to survival . RESULTS There were no changes in QoL after treatment . The number of QoL responders ( CG arm , 12 % ; CP arm , 5 % ) was not significantly different . CGA items were only associated with neuropsychiatric toxicity . Quality -adjusted survival was not different between treatment arms . The PC analysis derived from nine CGA , six QoL and one PS score indicated only one dominant dimension . This dimension was strongly prognostic , and physical and role functioning , Groningen Frailty Indicator and Geriatric Depression Scale were its largest contributors . CONCLUSIONS Paclitaxel or gemcitabine added to carboplatin did not have a differential effect on global QoL. CGA was associated with toxic effects in a very limited manner . CGA and QoL items measure one underlying dimension , which is highly prognostic Purpose Lung cancer chemotherapy decisions in patients ≥70 years old are complex because of toxicity , comorbidity and the limited data on patient preferences . We examined the relationships between preferences and chemotherapy use in this group of patients . Methods and patients We used a question naire describing four hypothetical lung cancer treatment options .  Eighty-three elderly ( ≥70 years old ) lung cancer patients were informed about their diagnosis and therapeutic choices and then asked to choose one of the four options . Patients had previously been included in a prospect i ve study to explore geriatric evaluation in an oncology unit and all had given written informed consent . Results Older patients ( n=83 ) diagnosed with lung cancer ( non-small- and small-cell lung cancer ) from January 2006 to February 2008 were recruited from a single centre . The mean patient age was 77 years ( range : 70–91 ) . Eighty-one patients ( 97.6 % ) were men . Non-small-cell lung cancer ( NSCLC ) was the diagnosis in 63 patients ( 76 % ) . Most patients selected active treatment ( 38.6 % most survival benefit , 18 % less survival benefit ) and 31.3 % selected no active treatment . Elderly lung cancer patients were significantly more likely to accept aggressive treatments despite high reported toxicities . Although most of the patients were symptomatic at diagnosis , the “ symptom relief ” option was chosen less frequently than the options that could prolong survival . Factors significantly related to patients ’ attitude toward chemotherapy were age ( p<0.001 ) , frailty ( p=0.0039 ) , depression and poor performance status ( PS ) . Conclusion Elderly lung cancer patients want to be involved in the decision-making process . Survival was the main treatment objective for more than half of the patients in this study . We have not found other published studies about elderly lung cancer patients ’ decisions about chemotherapy As a result of an increasing life expectancy , the incidence of cancer cases diagnosed in the older population is rising . Indeed , cancer incidence is 11-fold higher in persons over the age of 65 than in younger ones . Despite this high incidence of cancer in older patients , solid data regarding the most appropriate approach and best treatment for older cancer patients are still lacking , mostly due to under-representation of these patients in prospect i ve clinical trials . The clinical behaviour of common malignant diseases , e.g. breast , ovarian and lung cancers , lymphomas and acute leukaemias , may be different in older patients because of intrinsic variation of the neoplastic cells and the ability of the tumour host to support neoplastic growth . The decision to treat or not these patients should be based on patients ' functional age rather than the chronological age . Assessment of patients ' functional age includes the evaluation of health , functional status , nutrition , cognition and the psychosocial and economic context . The purpose of this paper is to focus on the influence of age on cancer presentation and cancer management in older cancer patients and to provide suggestions on clinical trial development and methodology in this population PURPOSE To identify Comprehensive Geriatric Assessment ( CGA ) components independently associated with changes in planned cancer treatment . PATIENTS AND METHODS We prospect ively included 375 consecutive elderly patients with cancer ( ELCAPA01 study ) assessed by geriatricians using the CGA .  Multivariate analysis was used to identify factors associated with changes in the cancer treatment ( intensification , decrease , or delayed > 2 weeks ) . Change was defined as a difference between the initial treatment proposal and the final treatment selected in a multidisciplinary meeting . RESULTS Mean age was 79.6 years ( st and ard deviation [ SD ] , 5.6 years ) , and 197 ( 52.5 % ) were women . The most common tumor location was the digestive system ( 58.7 % ) . The mean number of comorbidities was 4.2 ( SD , 2.7 ) per patient , and the mean Cumulative Illness Rating Scale for Geriatrics score was 11.8 ( SD , 5.3 ) . After the CGA , the initial cancer treatment plan was modified for 78 ( 20.8 % ) of 375 patients ( 95 % CI , 16.8 to 25.3 ) , usually to decrease treatment intensity ( 63 [ 80.8 % ] of 78 patients ) . By univariate analysis , cancer treatment changes were associated with Eastern Cooperative Oncology Group performance status ≥ 2 ( 73.3 % in the group with changes v 41.1 % in the in the group without changes ; P < .001 ) , dependency for one or more activities of daily living ( ADL ; 59.0 % v 24.2 % ; P < .001 ) , malnutrition ( 81.8 % v 51.2 % ; P < .001 ) , cognitive impairment ( 38.5 % v 24.9 % ; P = .023 ) , depression ( 52.6 % v 21.7 % ; P < .001 ) , and greater number of comorbidities ( mean , 4.8 [ SD , 2.9 ] v 4.0 [ SD , 2.6 ] ; P = .02 ) . By multivariate analysis , factors independently associated with cancer treatment changes were a lower ADL score ( odds ratio [ OR ] , 1.25 per 0.5-point decrease ; CI , 1.04 to 1.49 ; P = .016 ) and malnutrition ( OR , 2.99 ; CI , 1.36 to 6.58 ; P = .007 ) . CONCLUSION Functional status assessed by the ADL score and malnutrition were independently associated with changes in cancer treatment OBJECTIVE Current chemotherapy protocol s for gastric cancer present high toxicity . The FOLFIRI regimen has shown promising results with elderly colorectal cancer patients and for gastric cancer patients but this is the first report on elderly gastric cancer patients . DESIGN In this multicenter non-r and omized phase II trial , we administered the FOLFIRI chemotherapy protocol ( irinotecan [ 180 mg/m(2 ) ] , fluorouracil [ 5-FU ] [ 400 mg/m(2 ) ] and folinic acid 400 mg/m(2 ) or 200mg/m(2 ) of l-folinic acid ) to patients aged over 70 years with locally-advanced or metastatic gastric cancer combined with Comprehensive Geriatric Assessment ( CGA ) . Responses were assessed at 2 months . RESULTS Forty-two patients received eight cycles of the FOLFIRI regimen , with 82.5 % of patients showing disease control : 10 patients ( 26 % ) showing objective ( partial or complete ) responses and 23 ( 57.5 % ) showing stable disease . One-year overall survival ( OS ) was 41.5 % [ 95%CI 26.5 - 56.0 ] and one-year progression-free survival ( PFS ) was 31.8 % [ 95%CI 18.4 - 46.1 % ] . We observed 10 Grade 3/4 hematologic toxicities with one febrile neutropenia . CGA data demonstrated that geriatric functions were not altered by treatment and that nutritional status improved over treatment . CONCLUSIONS Results show excellent disease control and relatively high survival rates with limited toxicity similar to younger patients indicating that this regimen should be considered as a possible treatment in advanced gastric cancer of the elderly Few data are available to help predict which older cancer patient is 
    Output:
    
agent
Consistent with our previous review , several domains of GA are associated with adverse outcomes .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Development of a geriatric screening tool is necessary to identify elderly cancer patients who would benefit from comprehensive geriatric assessment ( CGA ) .  We develop and evaluate the G-8 screening tool against various reference tests . PATIENTS AND METHODS Analyses were based on 364 cancer patients aged>70 years scheduled to receive first-line chemotherapy included in a multicenter prospect i ve study . The G-8 consists of seven items from the Mini Nutritional Assessment ( MNA ) question naire and age . Our primary reference test is based on a set of seven CGA scales : Activities Daily Living ( ADL ) , Instrumental ADL , MNA , Mini-Mental State Exam , Geriatric Depression Scale , Cumulative Illness Rating Scale-Geriatrics , and Timed Get Up and Go . We considered the presence of at least one question naire with an impaired score as an abnormal reference exam . Additional reference exams are also discussed . RESULTS The prevalence of being at risk varied from 60 % to 94 % according to the various definitions of the reference test . When considering the primary reference test , a cut-off value of 14 for the G-8 tool provided a good sensitivity estimate ( 85 % ) without deteriorating the specificity excessively ( 65 % ) . CONCLUSION The G-8 shows good screening properties for identifying elderly cancer patients who could benefit from CGA Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies , posing the dilemma of whether to intensify therapy , thereby improving the cure rate , or de-escalate therapy , thereby reducing toxicity , with consequent risks for under- or overtreatment . Adequate tools to define doses and combinations have not been identified for lymphoma patients . We conducted a prospect i ve trial aim ed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment ( CGA ) in elderly ( aged ≥70 years ) patients with diffuse large B-cell lymphoma ( DLBCL ) . In June 2000 to March 2006 , 100 patients were stratified using a CGA into three groups ( fit , unfit , and frail ) , and they received a rituximab plus cyclophosphamide , doxorubicin , vincristine , and prednisone modulated in dose and drugs according to comorbidities and activities of daily living ( ADL ) and instrumental ADL scores . Treatment was associated with a complete response rate of 81 % and mild toxicity : grade 4 neutropenia in 14 % , anemia in 1 % , and neurological and cardiac toxicity in 2 % of patients . At a median follow-up of 64 months , 51 patients were alive , with 5-year disease-free , overall , and cause-specific survival rates of 80 % , 60 % , and 74 % , respectively . Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL . Wide use of this CGA-driven treatment may result in better cure rates , especially in fit and unfit patients Background : Elderly cancer patients form a heterogeneous population in which therapeutic decision-making is often difficult . The aim of this r and omised phase II trial was to evaluate the feasibility and activity of weekly docetaxel/gemcitabine ( DG ) followed by erlotinib after progression ( arm A ) vs erlotinib followed by DG after progression ( arm B ) in fit elderly patients with advanced non small-cell lung cancer ( NSCLC ) . Methods : Elderly chemotherapy-naive patients with stage IIIB/IV NSCLC were selected after a comprehensive geriatric assessment ( socioeconomic , cognitive , depression , ADL and IADL assessment s ) . The primary endpoint was the time to second progression ( TTP2 ) . Overall survival ( OS ) , the time to first progression ( TTP1 ) and safety were secondary endpoints . Results : Between July 2006 and November 2008 , 22 centres enrolled 100 patients .  TTP2 was 7.5 and 5.8 months in arm A and arm B , respectively ; TTP1 was 4.7 and 2.7 months ; and the median OS time was 9.4 and 7.1 months ; the respective 1-year survival rates were 36.2 and 31.4 % . There was no major unexpected toxicity . Conclusion : These results suggest that weekly DG , followed by erlotinib , is a promising treatment for fit elderly patients with NSCLC ; the efficacy of the reverse sequence was insufficient to recommend it for EGFR-non-selected patients BACKGROUND Elderly patients with advanced non-small-cell lung cancer ( NSCLC ) may derive similar benefit from platinum-based chemotherapy as younger patients .  Quality of life ( QoL ) and comprehensive geriatric assessment ( CGA ) is often advocated to assess benefits and risks . PATIENTS AND METHODS A total of 181 chemotherapy-naive patients [ ≥70 years , performance score ( PS ) of 0 - 2 ] with stage III-IV NSCLC received carboplatin and gemcitabine ( CG ) ( n = 90 ) or carboplatin and paclitaxel ( CP ) ( n = 91 ) every 3 weeks for up to four cycles . Primary end point was change in global QoL from baseline compared with week 18 . Pretreatment CGA and mini geriatric assessment during and after treatment were undertaken . A principal component ( PC ) analysis was carried out to determine the underlying dimensions of CGA and QoL and subsequently related to survival . RESULTS There were no changes in QoL after treatment . The number of QoL responders ( CG arm , 12 % ; CP arm , 5 % ) was not significantly different . CGA items were only associated with neuropsychiatric toxicity . Quality -adjusted survival was not different between treatment arms . The PC analysis derived from nine CGA , six QoL and one PS score indicated only one dominant dimension . This dimension was strongly prognostic , and physical and role functioning , Groningen Frailty Indicator and Geriatric Depression Scale were its largest contributors . CONCLUSIONS Paclitaxel or gemcitabine added to carboplatin did not have a differential effect on global QoL. CGA was associated with toxic effects in a very limited manner . CGA and QoL items measure one underlying dimension , which is highly prognostic Purpose Lung cancer chemotherapy decisions in patients ≥70 years old are complex because of toxicity , comorbidity and the limited data on patient preferences . We examined the relationships between preferences and chemotherapy use in this group of patients . Methods and patients We used a question naire describing four hypothetical lung cancer treatment options .  Eighty-three elderly ( ≥70 years old ) lung cancer patients were informed about their diagnosis and therapeutic choices and then asked to choose one of the four options . Patients had previously been included in a prospect i ve study to explore geriatric evaluation in an oncology unit and all had given written informed consent . Results Older patients ( n=83 ) diagnosed with lung cancer ( non-small- and small-cell lung cancer ) from January 2006 to February 2008 were recruited from a single centre . The mean patient age was 77 years ( range : 70–91 ) . Eighty-one patients ( 97.6 % ) were men . Non-small-cell lung cancer ( NSCLC ) was the diagnosis in 63 patients ( 76 % ) . Most patients selected active treatment ( 38.6 % most survival benefit , 18 % less survival benefit ) and 31.3 % selected no active treatment . Elderly lung cancer patients were significantly more likely to accept aggressive treatments despite high reported toxicities . Although most of the patients were symptomatic at diagnosis , the “ symptom relief ” option was chosen less frequently than the options that could prolong survival . Factors significantly related to patients ’ attitude toward chemotherapy were age ( p<0.001 ) , frailty ( p=0.0039 ) , depression and poor performance status ( PS ) . Conclusion Elderly lung cancer patients want to be involved in the decision-making process . Survival was the main treatment objective for more than half of the patients in this study . We have not found other published studies about elderly lung cancer patients ’ decisions about chemotherapy As a result of an increasing life expectancy , the incidence of cancer cases diagnosed in the older population is rising . Indeed , cancer incidence is 11-fold higher in persons over the age of 65 than in younger ones . Despite this high incidence of cancer in older patients , solid data regarding the most appropriate approach and best treatment for older cancer patients are still lacking , mostly due to under-representation of these patients in prospect i ve clinical trials . The clinical behaviour of common malignant diseases , e.g. breast , ovarian and lung cancers , lymphomas and acute leukaemias , may be different in older patients because of intrinsic variation of the neoplastic cells and the ability of the tumour host to support neoplastic growth . The decision to treat or not these patients should be based on patients ' functional age rather than the chronological age . Assessment of patients ' functional age includes the evaluation of health , functional status , nutrition , cognition and the psychosocial and economic context . The purpose of this paper is to focus on the influence of age on cancer presentation and cancer management in older cancer patients and to provide suggestions on clinical trial development and methodology in this population PURPOSE To identify Comprehensive Geriatric Assessment ( CGA ) components independently associated with changes in planned cancer treatment . PATIENTS AND METHODS We prospect ively included 375 consecutive elderly patients with cancer ( ELCAPA01 study ) assessed by geriatricians using the CGA .  Multivariate analysis was used to identify factors associated with changes in the cancer treatment ( intensification , decrease , or delayed > 2 weeks ) . Change was defined as a difference between the initial treatment proposal and the final treatment selected in a multidisciplinary meeting . RESULTS Mean age was 79.6 years ( st and ard deviation [ SD ] , 5.6 years ) , and 197 ( 52.5 % ) were women . The most common tumor location was the digestive system ( 58.7 % ) . The mean number of comorbidities was 4.2 ( SD , 2.7 ) per patient , and the mean Cumulative Illness Rating Scale for Geriatrics score was 11.8 ( SD , 5.3 ) . After the CGA , the initial cancer treatment plan was modified for 78 ( 20.8 % ) of 375 patients ( 95 % CI , 16.8 to 25.3 ) , usually to decrease treatment intensity ( 63 [ 80.8 % ] of 78 patients ) . By univariate analysis , cancer treatment changes were associated with Eastern Cooperative Oncology Group performance status ≥ 2 ( 73.3 % in the group with changes v 41.1 % in the in the group without changes ; P < .001 ) , dependency for one or more activities of daily living ( ADL ; 59.0 % v 24.2 % ; P < .001 ) , malnutrition ( 81.8 % v 51.2 % ; P < .001 ) , cognitive impairment ( 38.5 % v 24.9 % ; P = .023 ) , depression ( 52.6 % v 21.7 % ; P < .001 ) , and greater number of comorbidities ( mean , 4.8 [ SD , 2.9 ] v 4.0 [ SD , 2.6 ] ; P = .02 ) . By multivariate analysis , factors independently associated with cancer treatment changes were a lower ADL score ( odds ratio [ OR ] , 1.25 per 0.5-point decrease ; CI , 1.04 to 1.49 ; P = .016 ) and malnutrition ( OR , 2.99 ; CI , 1.36 to 6.58 ; P = .007 ) . CONCLUSION Functional status assessed by the ADL score and malnutrition were independently associated with changes in cancer treatment OBJECTIVE Current chemotherapy protocol s for gastric cancer present high toxicity . The FOLFIRI regimen has shown promising results with elderly colorectal cancer patients and for gastric cancer patients but this is the first report on elderly gastric cancer patients . DESIGN In this multicenter non-r and omized phase II trial , we administered the FOLFIRI chemotherapy protocol ( irinotecan [ 180 mg/m(2 ) ] , fluorouracil [ 5-FU ] [ 400 mg/m(2 ) ] and folinic acid 400 mg/m(2 ) or 200mg/m(2 ) of l-folinic acid ) to patients aged over 70 years with locally-advanced or metastatic gastric cancer combined with Comprehensive Geriatric Assessment ( CGA ) . Responses were assessed at 2 months . RESULTS Forty-two patients received eight cycles of the FOLFIRI regimen , with 82.5 % of patients showing disease control : 10 patients ( 26 % ) showing objective ( partial or complete ) responses and 23 ( 57.5 % ) showing stable disease . One-year overall survival ( OS ) was 41.5 % [ 95%CI 26.5 - 56.0 ] and one-year progression-free survival ( PFS ) was 31.8 % [ 95%CI 18.4 - 46.1 % ] . We observed 10 Grade 3/4 hematologic toxicities with one febrile neutropenia . CGA data demonstrated that geriatric functions were not altered by treatment and that nutritional status improved over treatment . CONCLUSIONS Results show excellent disease control and relatively high survival rates with limited toxicity similar to younger patients indicating that this regimen should be considered as a possible treatment in advanced gastric cancer of the elderly Few data are available to help predict which older cancer patient is 
    Output:
    