KEY TAKEAWAYS
- The CARE-Heme trial aimed to evaluate SFI as a screening tool to identify pts needing GA and frailty assessment.
- The study compared the sensitivity and specificity of SFI and IMWG-FI for frailty assessment in MM and calculated the net benefit of a two-step frailty assessment using SFI.
- The study suggested that a two-step frailty assessment strategy using SFI reduces unnecessary GAs by 40-45%, suggesting its suitability for busy oncology practice.
IMWG-FI predicts toxicity and mortality in older adults with multiple myeloma (MM) but requires a time-consuming geriatric assessment(GA). The simplified frailty index(SFI), a simpler ECOG PS index, has moderate concordance with the International Myeloma Working Group Frailty Index (IMWG-FI).
Researchers aimed to evaluate SFI as a screening tool to identify patients needing GA and frailty assessment.
The study enrolled pts aged 50 and older with newly diagnosed or relapsed/refractory(R/R) MM who were starting a new treatment regimen (1st to 6th line). Before initiating a new treatment, all pts underwent a GA, and they gathered information on ECOG performance status and comorbidities from their medical records. They calculated IMWG-FI and SFI using established methods and determined the sensitivity and specificity of both SFI and IMWG-FI using established SFI cutoff values. The decision curve analysis (DCA) method assessed the benefit of using SFI for frailty screening in detecting non-frail pts and reducing unnecessary GAs. They considered threshold probabilities of 0.25 and 0.33, indicating that missing an unfit patient was 3 and 2 times worse, respectively, than subjecting a fit patient to an unnecessary GA (odds of 1:3 and 1:2) and measured the net benefit (NB) of this two-step frailty assessment approach compared to performing GAs for all pts, focusing on the reduction in unnecessary GAs.
Of 146 adults with MM(49 ND-MM, 51 pre-transplant, and 46 RR-MM) and starting a new line of therapy. The median age was 62 (IQR 57-70), with 53% males and 36% blacks. The distribution by IWMG-FI was 43% fit, 32% intermediate fit, and 25% frail. Using SFI, 32% of patients were frail. Using a cutpoint of ≥2, SFI as a screening tool had a sensitivity of 89.2% (95% CI 75-96%) and a specificity of 65% (95% CI 56% to 73%). DCA showed that selecting candidates for GA based on a two-step strategy (SFI followed by IMWG-FI) led to an absolute 40-45% reduction in unnecessary GAs without missing frail patients.
The study suggested that a two-step frailty assessment strategy using SFI reduces unnecessary GAs by 40-45%, suggesting its suitability for busy oncology practice.
Source: https://ascopubs.org/doi/abs/10.1200/JCO.2023.41.16_suppl.8061
Clinical Trial: https://clinicaltrials.gov/study/NCT05556928
Andrew Gahagan, Monica Sai Pasala, Clare Ubersax, Abigail Tucker, Christian Harmon, Susan Bal, Kelly Nicole Godby, Gayathri Ravi, Luciano J. Costa, Grant Richard Williams, and Smith Giri. DOI: 10.1200/JCO.2023.41.16_suppl.8061 Journal of Clinical Oncology 41, no. 16_suppl (June 01, 2023) 8061-8061.
