Despite the high prevalence of malignancies in elderly people, and the advances in the past two decades in new cancer medicines and technologies, offering elderly patients with cancer an optimal treatment still remains a challenge. Until recently, randomized controlled trials in oncology have frequently excluded older patients due to their chronological age or the presence of comorbidities. The consequent scarcity of data and lack of guidelines contribute to a situation where under- or over-treatment of elderly patients with cancer is common. Since the population is aging, improvement of the management of older patients with cancer is becoming a major issue
The objective of PrIME (Program for Improved Management of Elders with cancer) is to combine multiple approaches in order to improve the outcome of elderly patients with cancer through individualisation of treatment and management.
PrIME coordinators :
PrIME strategy involves the following domains of intervention :
- A better identification of vulnerable patients before treatment of cancer : the objective will be to refine the selection process with geriatric assessment tools and blood biomarkers; it will allow us identifying geriatric impairments and classifying older patients in risk groups according to treatment;
- A better understanding of tumour biology in older patients, searching for specificities of the behaviour of tumour cells in an environment altered by the aging process. We hypothesise that accumulation of aging-related defects in normal tissues (genetic and functional alterations of cells including the immune system, accumulation of senescent cells and the associated secretome) alter tumour cell behaviour which should have significant impact on treatment strategy;
- Improvement of treatment including both refinement of treatment strategy with the evaluation of validity and cost-effectiveness of geriatric intervention in vulnerable older patients with cancer and identification of appropriate endpoints for treatment;
- Whatever the optimisation of treatment achieved, appropriate treatment and management is not accessible to many older patients because of familial, cultural or geographical reasons, especially in a large region such as Nouvelle-Aquitaine. The objective is to identify inequalities, then to correct them with public health interventions.
Each of these domains are representated by a task (divided itself in several research projects) within the program.
The first task « Identification of vulnerable patient » is led by DrCamille Chakiba, oncologist at Institut Bergonié and Dr Isabelle Pellegrin, medical biologist at CHU Bordeaux.
« Understand oncogenesis in older patients » is led by Dr Raul Duran, research scientist at Institut européen de chimie et de biologie IECB and Dr Frederic Delom;
« Better treat patients according to risks » is led by Dr Carine Bellera, biostatistician, member of the research team Epidémiologie des cancers et exposition environnementale EPICENE, Inserm and Dr Thomas Grellety, oncologist at Institut Bergonié.
The last task « Ensure that older patients get access to standard of care wherever he/she lives » is led by Dr Pernelle Noize, medical pharmacology department at CHU Bordeaux, Béatrices Jacques lecturer in sociology at Bordeaux University and Dr Alain Monnereau, member of the research team EPICENE.[ Page under construction… ]