The aim was to investigate if oncologic treatment decision based on G8 screening followed by comprehensive geriatric assessment (CGA) and a multidisciplinary team conference in patients with G8 ≤ 14 was better than treatment decision based on standard assessment. ClinicalTrials.gov Identifier: NCT02671994. From January 2016 to June 2018, 96 patients with cancer, aged ≥70 years, were included. Patients were randomized to treatment decision based on the oncologist's clinical judgement (control) or based on screening with G8. If G8 > 14 treatment decision was made as in the control group and if G8 ≤ 14, patients were referred to CGA including intervention as needed and treatment decision after a multidisciplinary team conference (MDT). The study was closed early. 47 patients were randomized to the control group and 49 to the intervention group; 28 had a G8 ≤ 14, 24 of whom attended CGA. In the intervention group 48% completed treatment as planned compared to 54% in the control group (p = .208). Thirty-eight percent experienced grade 3-4 toxicity in the control group compared with only 20% in the intervention group (p = .055). Median overall survival (OS) was 14.2 months in the control group and 19.1 months in the intervention group (p = .911). Median progression-free survival (PFS) was 9.0 months in the control group and 7.8 months for the intervention group (p = .838). Treatment decision based on G8 screening followed by CGA had no impact on completion rate of planned oncologic treatment, OS or PFS, but resulted in a borderline significant lower incidence of grade 3-4 toxicity.

Background The number of older patients with cancer is increasing in general, and ovarian and endometrial cancer are to a large extent cancers of the elderly. Older patients with cancer have a high prevalence of comorbidity. Comorbidity and age may be predictive of treatment choice and mortality in older patients with cancer along with stage and performance status. Objectives The aim of this study was to describe comorbidity in a population of older Danish patients with gynecological cancer, and to evaluate the predictive value of comorbidity and age on treatment choice and cancer-specific and all-cause mortality. Materials and methods In this retrospective study, we included 459 patients aged ≥ 70 years. Patients were diagnosed with cervical, endometrial, or ovarian cancer from 1 January, 2007 to 31 December, 2011 and were evaluated and/or treated at Odense University Hospital. Comorbidity was assessed using the Charlson Comorbidity Index. Treatment was classified as curative intended, palliative intended, or no treatment. Results Age, International Federation of Gynecology and Obstetrics (FIGO) stage, and performance status were found to be significant predictors of treatment choice, while comorbidity was not. Multivariate analyses showed that both cancer-specific and all-cause mortality were significantly associated with treatment choice, FIGO stage, and performance status. Age was not associated with mortality, with the exception of ovarian cancer, where age was associated with all-cause mortality. Comorbidity was not an independent predictor of treatment choice or mortality. Conclusions In our population of older Danish patients with gynecological cancer, age, FIGO stage, and performance status were predictors of treatment choice, while comorbidity was not. Treatment choice, FIGO stage, and performance status were significantly associated with both cancer-specific and all-cause mortality. Age was only associated with mortality in ovarian cancer, while comorbidity was not associated with mortality.

Background: Little is known about the biological factors influencing ovarian cancer (OC) patient outcome, especially in older patients who are often underrepresented in clinical trials. We examined alterations in the transcriptomic profile of primary high-grade serous carcinoma (HGSC) samples from older OC patients (>70 years) receiving first-line platinum-based treatment to identify potential biomarkers for prediction of response to this therapy. Material and methods: Tumor samples from 50 HGSC patients were identified from a retrospective cohort, analyzed by gene expression array. The protein expression of selected biomarkers was examined using immunohistochemistry (IHC). Results: Gene expression profiling revealed 81 genes with significantly altered expression in patients experiencing progression after first-line platinum-based treatment within 6 months versus those who progressed later than 12 months. Expression of ankyrin repeat and PH domain 1 (ARAP1) was significantly lower in the group with early versus late progression (p ≤ .01). Correlation between ARAP1 expression and outcome was further confirmed by IHC staining in the discovery cohort (χ²-test, p = .004) and in independent validation cohorts. The sensitivity of ARAP1 allowed identification of 64.7% of patients with early progression in the discovery population, with a specificity of 78.6% and a negative predictive value of 78.6%. Multivariate regression analysis identified ARAP1 as an independent prognostic factor. Conclusions: This hypothesis generating study suggests that low expression of ARAP1 is an independent prognostic biomarker of shorter RFS in older patients with HGSC receiving first-line platinum-based antineoplastic therapy, which could be used to identify patients who should receive more intensive treatment and closer surveillance.

Background: Adjuvant anti-PD-1 therapy improves recurrence-free survival (RFS) in high-risk melanoma, but many patients experience adverse events. 2-deoxy-2-[¹⁸F]fluoro-D-glucose positron emission tomography with computed tomography [¹⁸F]FDG-PET/CT has been proposed to identify biomarkers that may predict outcome of treatment. Objectives: The aim of this register-based study was to investigate the prognostic value of immune-related adverse events (irAEs), spleen-to-liver ratio (SLR), and bone marrow-to-liver ratio (BLR), detected by [¹⁸F]FDG-PET/CT. Methods: This retrospective, register-based cohort study included 122 patients with radically resected stage III–IV melanoma treated with adjuvant anti-PD-1. Patient data were extracted from a Danish register, and measurements for SLR and BLR were made using an AI model. Cox regression models were made on irAEs and BLR to assess associations with RFS and overall survival (OS). Results: Over half of the patients experienced recurrence, and one quarter died during follow-up of 4 ¾ years. Seventy-four percent exhibited at least one PET-detected irAE. This study found no association between irAEs and OS. Regarding RFS, our findings suggest an increased risk of recurrence for the presence of irAEs within the first 1.5 years of follow-up (HR: 2.93, CI: 1.10–7.84, p = 0.032). BLR and SLR were not associated with RFS or OS in multivariable models. Conclusions: This study did not confirm the findings of a positive association between irAEs and survival found in previous studies. PET-detected irAEs were common in the study population, but did not predict OS, while early-onset irAEs were linked to increased recurrence risk. Neither SLR nor BLR demonstrated prognostic value. Further research is needed to clarify the clinical utility of PET-derived biomarkers, especially in the adjuvant setting.

The use of immune checkpoint inhibitors has evolved over the past decade, leading to increased survival in several cancers, including metastatic melanoma. However, the activation of the immune system can cause immune-related adverse events (irAEs), some of which may be potentially fatal. Several irAEs can be visualised on ¹⁸ F-fluorodeoxyglucose positron emission tomography/CT ( ¹⁸ F-FDG PET/CT), but only a few short cases of immune-related hepatitis have been described in the literature. This case describes thoroughly a course of immune-related hepatitis visualised on a scheduled ¹⁸ F-FDG PET/CT performed to assess treatment response in a patient treated with combination immunotherapy (ipilimumab and nivolumab) for metastatic melanoma. Although rare, this irAE can be fatal and highlights the importance of assessing the liver when evaluating ¹⁸ F-FDG PET/CT scans and alerting clinicians in case of suspicious increased FDG uptake in the liver to optimise patient treatment and care.