The utility of a modified frailty index in predicting chemotherapy toxicity, response and survival for older patients (pts) with advanced pancreatic cancer receiving first-line palliative chemotherapy: A single institution experience.
Bibliographic record
Abstract
e22030 Background: Advanced pancreatic cancer (APC) primarily occurs in pts ≥ 65 years old. Chemotherapy decisions are challenging in this group. The Modified Frailty Index (mFI) is an 11-component measure of frailty which has been validated in surgical fields, but yet to be tested in older pts with APC receiving first-line palliative chemotherapy, with 5-fluorouracil, irinotecan and oxaliplatin (FOLFIRINOX), nab-paclitaxel and gemcitabine (NG), or gemcitabine alone (GEM). We sought to assess the correlation between mFI scores for older chemotherapy-treated APC pts with toxicity, response and survival. Methods: Pts ≥65 diagnosed with APC from 2011-2016 and treated with palliative chemotherapy at CancerCare Manitoba were identified from the Manitoba Cancer Registry. A retrospective analysis was performed to determine mFI scores for all pts based on 11 components (Nonindependent functional status, diabetes, chronic obstructive pulmonary disease, myocardial infarction, coronary artery disease, hypertension, congestive heart failure, peripheral vascular disease, transient ischemic attack, stroke, and impaired sensorium). Demographics, toxicity, response and survival were compared by mFI score. Results: 87 pts received chemotherapy, of which 20, 28, 25 and 14 had mFI scores of 0, 1, 2, and ≥ 3 respectively. Median age by mFI score was 69 (65-88), 73(65-80), 71(65-84) and 71(66-78), respectively. 52 pts received FOLFIRINOX (14 mFI 0, 19 mFI 1, 12 mFI 2, 7 mFI ≥ 3); 24 pts received NG and 14 pts received GEM. Neutropenia was similar (55%, 67.9%, 60%, 57.1% respectively), and there was no difference in other toxicities across mFI scores. Response rates were similar across mFI scores (p = 0.695), as were 6 and 12-month survival (p = 0.981 and p = 0.430, respectively). Conclusions: In elderly treated with chemotherapy for APC, retrospective mFI did not correlate with chemotherapy toxicity, response or survival. This may be due to small sample and the rigorous selection of older pts receiving chemotherapy for APC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".