SIOG 2015 – Abstract Submission – Invited Speakers

Journal of Geriatric Oncology 6 (2015) S1–S11

Ava i l a bl e o n l i n e a t w w w. s c i e n c e d i r e c t . c o m

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SIOG 2015 – Abstract Submission – Invited Speakers S01 ADVANCES IN GERIATRIC ONCOLOGY - UPDATE IN SUPPORTIVE CARE Christopher Steer Border Medical Oncology, Wodonga, Australia

The motto of the Multinational Association for Supportive Care in Cancer (MASCC) is that “supportive care makes excellent cancer care possible”. This is especially important in the care of older adults with cancer. Supportive care is multidisciplinary and involves the care of the patient throughout their cancer journey. There is significant overlap between the literature on screening and assessment of older adults with cancer and the provision and utilisation of supportive care strategies. In a series of 529 older patients with a diagnosis of cancer, Pergolotti and colleagues described the fact that whilst potentially modifiable functional deficits were more likely to be found in patients with increasing age, few patients were referred for physical therapy or rehabilitation services [1]. This finding led to a randomised trial of cancer rehabilitation as an intervention in older adults [2]. The role of the pharmacist in supportive care is especially relevant in older adults and is an important area of research. Nightingale and colleagues reported on a pharmacist-led intervention that led to the optimization of medication management in a series of 248 older adults with cancer [3]. In this report the prevalence of excessive polypharmacy and potentially inappropriate medication use was 43% (n = 101) and 51% (n = 119) respectively. The same team also report that complementary and alternative medicine (CAM) use in an older adult population is high and associated with polypharmacy [4]. The role of yoga as a supportive care intervention for cancerrelated fatigue was described in a publication from Sprod and colleagues [5]. In a randomised trial conducted in 97 older cancer survivors (the majority with a diagnosis of breast cancer) a 4 week yoga intervention as associated with reduction in cancer-related fatigue and global side effect burden. In a study designed to clarify the impact of age on supportive care needs Watson and colleagues found that, “with a few exceptions, individual rather than age-specific needs determine supportive and informational care requirements” [6]. This reinforces the tenet of caring for older adults with cancer – “Adequate assessment yields appropriate care”. Clinicians must not make assumptions on the basis of age alone. As part of a social media experiment I hope to discover other important research in this field through a twitter-survey or tweetchat. The results of this experience will be presented at the meeting. 1879-4068/$ – see front matter

References [1] Pergolotti M et al: The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer. J Geriatr Oncol 6:194-201, 2015 [2] Pergolotti M et al: A randomized controlled trial of outpatient CAncer REhabilitation for older adults: The CARE Program. Contemp Clin Trials 44:89-94, 2015 [3] Nightingale G et al: Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. J Clin Oncol 33:1453-9, 2015 [4] Nightingale G et al: A pharmacist-led medication assessment used to determine a more precise estimation of the prevalence of complementary and alternative medication (CAM) use among ambulatory senior adults with cancer. J Geriatr Oncol, 2015 [5] Sprod LK et al: Effects of yoga on cancer-related fatigue and global side-effect burden in older cancer survivors. J Geriatr Oncol 6:8-14, 2015 [6] Watson M et al: The influence of life stage on supportive care and information needs in cancer patients: does older age matter? Support Care Cancer 23:2981-8, 2015 Disclosure of interest: None declared Keywords: None

S02 UPDATE ON NEW RESEARCH FOR SURGERY IN ELDERLY CANCER PATIENTS 2014-2015 Mike Jaklitsch Harvard Medical School; Thoracic Surgery Attending at Brigham; Women’s Hospital in Boston

In the past year a number of articles and clinical trials were published discussing advances in innovation for geriatric oncology. Ten specific clinical trials published in the last year demonstrated an important shift in focus from improving surgical techniques for elderly patients to improving elderly patient assessment before and after surgery. These techniques will more accurately capture patients who will not tolerate surgery well – the occult frail patient who is not currently captured by standard assessment measures. Advancements in pre-operative assessments include a Frailty Index, Comprehensive Care plans and evaluations for Delirium during the post-operative stay. Further analysis of important

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comorbid conditions includes the relationship between hearing impairment and associated functional declines. Disclosure of interest: None declared Keywords: None

S03 UPDATE IN GERIATRICS Holly Holmes University of Texas Health Science Center, Houston, US

This session will provide a review of recent literature published in geriatrics that is relevant to geriatric oncology. The focus will be high-impact trials and other research that has the potential to lead to practice changes in geriatric oncology. Disclosure of interest: None declared Keywords: None

S04 UPDATE IN MEDICAL ONCOLOGY Ravindran Kanesvaran National Cancer Centre Singapore, Department of Medical Oncology, Singapore

Over the last decade there have been many advances in the way we treat older patients with cancer. More studies using systemic therapies are designed now to specifically incorporate older patients with cancer. With the advent of targeted therapies, a larger proportion of elderly cancer patients are now able to tolerate treatment with tolerable side effect profile. Experts in the field have also made large strides in coming up with tools like the CARG and CRASH scores that help us better decide which patients to give systemic treatments too. Of late there has been a lot of excitement in the field with the development of newer therapies using immunotherapy (immune checkpoint inhibitors). In this talk I will review the latest data about treatment options that have positively impacted the treatment of elderly cancer patients. Disclosure of interest: None declared Keywords: None

S06 BREAST CANCER IN OLDER ADULTS: UPDATE. Hans Wildiers University Hospital Gasthuisberg Leuven, Belgium

Breast cancer often occurs in older patients, and treatment plans for young patients are not always appropriate for older individuals. Concerning surgery, there is a trend to operate less and less. Involved lymph nodes at sentinel procedure are not followed anymore in all cases by axillary lymph node dissection. Older patients also benefit from this less aggressive approach.

Whole breast radiotherapy after breast conserving surgery, with a boost to the tumor bed, should be considered in all elderly patients since it decreases risk of local relapse. There is no subgroup of fit older patients in whom post-BCS WBRT can be systematically omitted but benefit in terms of overall survival can be very limited in low risk or frail patients. Hypofractionated radiation schedules offer similar local-regional control and adverse effects as standard fractionation regimens. Adjuvant treatment decisions are challenging since benefit for the individual patient cannot be measured immediately, and the decision process is actually a risk calculation. The decision to treat with adjuvant chemotherapy should not be age-based but rather on general tumor characteristics and general health status and personal preference. Fit older patients with node-positive, hormone-negative disease potentially derive the largest benefit. Several recent studies have evaluated different chemotherapy regimens that may be suitable for older cancer patients, as recently discussed in an editorial in Ann Oncol (see below). Recent studies and trends in breast oncology will be discussed. References [1] Biganzoli L, Wildiers H, Oakman C, et al. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol. 2012 Apr;13(4):e148-60. [2] Wildiers H, Kunkler I, Biganzoli L, et al. Management of breast cancer in elderly individuals: Recommendations of the International Society of Geriatric Oncology (SIOG). Lancet Oncol 2007; 8(12): 1101-15. [3] Wildiers H, Brain E. Different adjuvant chemotherapy regimens in older breast cancer patients?. Ann Oncol 2015 Apr;26(4):613-5 Disclosure of interest: None declared Keywords: None

S08 LUNG CANCER Ravindran Kanesvaran National Cancer Centre Singapore, Department of Medical Oncology, Singapore

More than half of all non-small cell lung cancer (NSCLC) patients and a third of small cell lung cancer (SCLC ) patients are above the age of 70 years. One third of NSCLC patients present with metastatic disease. In earlier stages of lung cancer( stage I– III) , standard therapy, whether its surgery followed by adjuvant therapy or concurrent chemotherapy and radiotherapy have all shown to provide the same benefit for older patients when compared to the young if the right patient is selected. This approach was found to provide similar benefit for elderly NSCLC patients in the metastatic setting as well. In SCLC, older patients were found to have higher toxicities when standard doses were used. When attenuated doses were used, efficacy dropped. As such older patients with SCLC should be assessed appropriately before a decision is made regarding the doses that should be used for them. We will go through the contemporary evidence to support the right treatment options for elderly lung cancer patients. Disclosure of interest: None declared Keywords: None

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S10 NEW CHALLENGES IN TREATMENT OF ELDERLY CLL PATIENTS Barbara Eichhorst University hospital of Cologne, Germany

With a median age of 72 years at diagnosis chronic lymphocytic leukemia (CLL) is a hematological malignancy affecting many elderly patients. For decades monotherapy with chlormabucil was the standard therapy for elderly and/or comorbid patients. This treatment was well tolerated, but rarely caused deep responses or longer lasting remission. Hence elderly patients were severely impacted by CLL with regard to their survival. With more intensive treatment regimen, combinations of chemotherapy and antibodies, becoming standard in younger and/or physically fit patients, concomitant diseases and physically fitness play a major role for the selection of treatment. So far, there is no ideal tool to measure the comborbidity burden, but a geriatric assessment before treatment initiation is strongly recommended. While full dosed chemoimmunotherapy regimen, such as FCR, are frequently associated with high toxicity rates in elderly, dose reduced regimen or milder chemoimmunotherapy are better tolerated and yield promising results. The combination chlorambucil plus CD20 antibody has become the new standard first line therapy in many countries because it yields long progression free survival rates. The combination of chlorambucil plus obinutuzumab yielded even an overall survival benefit. With the approval of new drugs inhibiting kinases attached to the B cell receptor better treatment options are now available for CLL patients with genetically high risk disease or relapsed disease. Though these substances show excellent results because of the fact, that they are administered as continuous treatment being associated with mild toxicity and drug interactions, studies will have to show long term results. However, with the actual rapid development in treatment of CLL also elderly patients benefit from new substances. The selection of the optimal treatment remains still challenging. Disclosure of interest: None declared Keywords: None

S12 SYSTEMIC INFLAMMATION, GERIATRIC ASSESSMENT, AND TREATMENT OUTCOMES AMONG OLDER ADULTS TREATED INTENSIVELY FOR ACUTE MYELOGENOUS LEUKEMIA (AML) Heidi Klepin1,*, J. A. Tooze2, B. J. Nicklas3, S. B. Kritchevsky3, J. D. Williamson3, L. R. Ellis1, B. L. Powell1, T. S. Pardee1 1 Hematology and Oncology, 2Biostatistics, 3Geriatrics and Gerontology, Wake Forest School of Medicine, Winston Salem, United States

Introduction: Older adults treated for acute myelogenous leukemia (AML) are more likely to experience toxicity and shorter survival than younger patients. Treatment-associated toxicity may negatively affect physical, emotional and cognitive health. Investigations of biologic mechanisms that contribute to poor outcomes for older adults may inform design of supportive care interventions. Objectives: To investigate the relationship between systemic biomarkers of inflammation, geriatric assessment (GA) measures, and treatment outcomes among older adults treated intensively for AML

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Methods: We conducted an ancillary study (N=20) within a single institution observational trial (N=74) that investigated the predictive utility of GA among older adults treated intensively for AML. Eligibility included age ≥60 yrs, newly diagnosed AML, and planned intensive induction. A GA (including Short Physical Performance Battery [SPPB], Instrumental Activities of Daily Living [IADLs], Center for Epidemiologic Studies Depressions scale [CES-D] and Modified Mini-mental State Exam [3MS]) was performed at baseline for induction and at first follow-up post induction hospitalization. On the ancillary study, biomarkers of inflammation (IL-6, IL-6 soluble receptor [IL-6 sR], TNF, TNF soluble receptor [TNF sR], IL-3, C-reactive protein [CRP]) were collected at baseline and follow-up. Cytokines and cytokine soluble receptors were assayed with commercially available (R&D Systems, Minneapolis, MN) enzyme-linked immunosorbent assay (ELISA) kits. Treatment outcomes were 14-day cytoreduction (Y/N) measured on bone marrow exam and overall survival (OS) from treatment initiation. Analyses included descriptive statistics, correlations and logistic regression (for cytoreduction). OS was analyzed using Kaplan-Meier methods and Cox proportional hazards models. A two-sided alpha level of 0.05 was used to indicate statistical significance. Results: Among 20 participants, the mean age was 68 yrs; 85% were evaluable for follow-up GA. The majority (95%) had intermediate/poor risk cytogenetics. Most (90%) received therapy with anthracycline, cytarabine ± etoposide. Median OS was 1.8 years with >4 years of follow-up. At baseline, there were no significant correlations between cytokine levels and cognition. Symptoms of distress correlated with TNF sR (r=0.49, p=.03) and CRP (r=0.47, p=0.04). Physical performance (SPPB score) was correlated with TNF sR (r=-0.45, p=.04). There was a trend toward correlation between depressive symptoms and IL-6 sR (r=-0.44, p=0.06). After adjustment for baseline score, change in SPPB, IADL, CES-D and distress scores from baseline to followup correlated with change in TNF sR (r =-0.54, p=0.03; r=0.82, p=0.002; r=0.60, p=0.02; r =0.52, p=0.04 respectively). Change in distress was also correlated with change in TNF (r =0.58, p=0.05). Considering treatment outcomes, higher baseline level of TNF sR was associated with a trend toward greater odds of cytoreduction (500 pg/mL OR 2.0, CI 0.99-4.0). After adjustment for age and cytogenetics, baseline levels of TNF and CRP above median were associated with higher mortality (HR 5.6, 95% CI 1.3-23.1 and HR 13.6, 95% CI 2.3-81.8 respectively). Conclusion: TNF and CRP warrant further study as biomarkers predictive of survival among older adults with AML. The relationship between TNF sR and both treatment response and change in physical and emotional health in the setting of AML therapy should be further investigated. Disclosure of interest: None declared Keywords: Acute myeloid leukemia, cytokine, geriatric assessment, mortality

S15 COGNITIVE IMPAIRMENT AND DELIRIUM Beatriz Korc Grodzicki Memorial Sloan Kettering Cancer Center (MSKCC); Weil Cornell Medical College, New York, NY

Cancer patients with cognitive dysfunction represent a new challenge for oncologists. After age 65 the risk of developing Alzheimer’s disease doubles about every 5 years. By age 85,

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nearly half of all people will have some signs of the disease. The increased rate of dementia in the elderly converges with the higher likelihood of developing cancer. Patients with cancer/dementia overlap are often diagnosed later in the disease process, screening is less standardized and adherence with treatment is often difficult. Impaired cognition can result in significant difficulties in understanding and remembering treatment instructions, delayed diagnosis of complications and less compliance with oral therapies and supportive treatments. Many oncologists are conflicted as to whether true informed consent for treatment can be obtained from older cancer patients when their cognitive abilities are impaired or unclear. It is imperative that health care providers that care for older adults with cancer be able to assess cognitive function, understand the implications of cognitive impairment when patients need to make decisions, address the potential for treatment-related further cognitive decline and be able to facilitate shared cancer-decision making that would be patient-centered. Delirium is a fluctuating disturbance in attention and awareness that represents a decline from baseline status, accompanied by cognitive dysfunction. It is the most common, serious neuropsychiatric complication in patients with cancer. It is associated with increased morbidity and mortality, increased length of hospitalizations, higher health care cost and significant distress for patients, family members and health professionals. In the patients with cancer the complexity of delirium is enhanced by the direct effects of cancer on the central nervous system (CNS) (i.e. brain metastatic disease) and the indirect CNS effects of the disease or its treatment. We will discuss the diagnosis of dementia vs. delirium, how delirium may interfere with the recognition of other symptoms such as pain and how this frequently unrecognized complication could be prevented and /or treated. Disclosure of interest: None declared Keywords: None

S16 POLYPHARMACY Holly Holmes University of Texas Health Science Center, Houston, USA

This session will provide an overview of the epidemiology and the adverse outcomes associated with the overuse of medication by older patients. The literature on polypharmacy specific to older patients with cancer will be reviewed and updated. Disclosure of interest: None declared Keywords: None

S17 TREATMENT ACCEPTABILITY AND SATISFACTION WITH CARE IN ELDERLY CANCER PATIENTS Anne Bredart Psychologue, Unité de Psycho-oncologie, Institut Curie, Paris, Laboratoire de Psychopathologie et Processus de Santé (LPPS), Equipe 3

Treatment acceptability and satisfaction with care may be particularly important for elderly cancer as treatment burden

and support from health care providers may particularly affect elderly cancer patients’ health-related quality of life. The objective of this presentation is to delineate the concepts of treatment acceptability and satisfaction with care for elderly cancer patients. This will be based on a qualitative study aimed to describe patients’ perception of targeted therapy “tolerability” and to explore their subjective experience of these treatments in terms of symptoms, functioning, health-related quality of life, and treatment satisfaction. Semi-structured interviews were carried out with 4 patients aged above 65 years old out of 10 patients affected with choroid melanoma, metastatic breast cancer or nasopharyngeal carcinoma. Qualitative data were analysed using the grounded theory approach. Results will be discussed in terms of their clinical application to elderly cancer patients. Disclosure of interest: None declared Keywords: None

S18 EDUCATIONAL INITIATIVES IN GERIATRIC ONCOLOGY - WHO, HOW, WHY? Tina Hsu The Ottawa Hospital Cancer Centre, Ottawa, Canada

With the aging of the population and the rising prevalence of cancer, clinicians will increasingly be caring for older adults with, at risk of, or with a history of, cancer. Currently oncologists and clinicians caring for cancer patients receive little training in caring for older adults, yet there are insufficient numbers of clinicians specially trained in geriatrics to address the unique needs of this population of patients. Similarly, oncology is a rapidly evolving and specialized field. Geriatricians often do not receive training specifically in the care of oncology patients and may not be able to optimally advise on certain issues unique to patients with cancer. This session will identify current gaps in training across several disciplines, highlight accomplishments and ongoing educational initiatives to address these gaps, and propose future areas of development needed to train the workforce to better address the needs of an aging cancer population. Disclosure of interest: None declared Keywords: None

S19 ADMINISTRATIVE AND FINANCIAL ISSUES IN GERIATRIC ONCOLOGY EDUCATION: A BRAZILAN EXAMPLE Aldo Dettino Clinical Oncology, A C Camargo Cancer Center & Clinica David Erlich, São Paulo, Brazil

In Geriatric Oncology (GO), ageism has to be avoided and bringing light to its importance is an up-to-date field. Despite all knowledge gained, there are still gaps in research, education and assistance. How to design trials? Which are important end points? How to optimize education to better information delivery and improve patients’ satisfaction with their assistance in dealing with cancer? How to apply geriatric assessment for improving interdisciplinary interventions? Remarkably, administrative and

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financial factors interfere with that. Some strategies that apply to GO teaching and learning have to be discussed, including how to optimize education, while dealing with administrative and financial issues. Fortunately, many ways of broadcasting knowledge were developed around the world. Regional and international symposiums bring learning opportunities nearer to other societies’ health professionals. Session will review those topics, describing administrative and financial aspects in GO implementation, discussing how they interfere and how to improve education and research, while offering good-quality assistance, based on the regional experience of the GO team, in A.C.Camargo academic cancer center, in Sao Paulo, Brazil, with a GO Unit responsible for the education and training, before the fellowship conclusion, of 18 clinical oncology physicians/year(y). Moreover, the center is responsible for the assistance of more than 10,000 patients/y, 20% over 70, and the realization of local and international symposiums, including sessions where geriatric oncology is discussed. Disclosure of interest: None declared Keywords: None

S20 THE SIOG EDUCATION INITIATIVE AND THE TREVISO COURSE Etienne Brain Department of Medical Oncology; Institut Curie - Hôpital René Huguenin

In our ageing society, education is a cornerstone dedicated to build the future. This entails teaching and learning to teach our closest colleagues from oncology and geriatrics worlds, developing and disseminating specific high-standard guidelines that advocate fine-tuned strategies in elderly cancer patients, creating educational workshops with practical cases, exploiting new technical capabilities as e-learning and webinars, and introducing further forward geriatric oncology in the world of university. History shows that major trends occurred when there was a stimulating environment conducive to learning, enabling genuine revolutions, as during the Italian Rinascimento, when cenacoli were well-intentioned and welcoming communities, where elders and youths reciprocally nurtured, inspired and educated each other, making of education the cement across generation, disseminating knowledge and large intellectual current, and eventually impacting on society and practice. This is the strong rationale for the development of the SIOG Treviso Advanced Post Graduate Course, under the initiative of both Silvio Monfardini and Giuseppe Colloca, with the support from the Università Cattolica del Sacro Cuore di Roma and the auspices of ASCO: July 2016 will see the third edition, after a certain fashion as a “Trevisian cenacolo”, a new cradle for geriatric oncology, resurrecting a long standing Italian tradition. The session will give us the opportunity to present you all the education initiatives launched by SIOG including dedicated fund raising. SIOG size (small but expanding friendly community) and structure (Science and Education Committee) harbours all the potential to tackle that role successfully. Disclosure of interest: None declared Keywords: None

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S22 POLYPHARMACY: IMPLICATIONS IN THE ELDERLY Holly Holmes University of Texas Health Science Center, Houston, USA

The use of many medicines is highly prevalent and problematic in older patients, who have a high burden of comorbidity and age-related changes in pharmacokinetics. This session will review current knowledge about the prevalence and impact of drug-drug interactions in older patients with cancer. Disclosure of interest: None declared Keywords: None

S23 EXAMPLES OF EXISTING RESOURCES TO LEARN ABOUT DDI Vincent Launay-Vacher Pitie-Salpetriere Hospital, Clinical Pharmacologist in the Department, Paris, France

Anticancer drugs may interfere with other treatments the patients receive, either for supportive care or for the treatment of comorbidities. Elderly cancer patients often present with associated diseases or impaired organ function, such as hypertension, diabetes, dyslipidemia, and/or impaired renal or liver function. Some chemotherapies and hormone therapies may present with potential drug-drug interactions (DDI) which may lead to toxicity or a lack of efficacy. Oral tyrosine kinase inhibitors (TKI) present with a high potential for DDI, especially due to their metabolism through the cytochrome P450 3A4 enzyme (CYP3A4). Recent immune therapies are free of metabolic DDI since all drugs so far are monoclonal antibodies which are not metabolized in the liver, but pharmacodynamic DDI may still occur. The absence of validated biomarkers of efficacy, and safety, requires anticipating potential DDIs and avoiding them, with changing, when possible, the associated medications rather than the anticancer drug. In this talk, available resources will be reviewed in order to provide the attendance with a list of selected sources. Disclosure of interest: None declared Keywords: None

S24 ONCOLOGY AND SUPPORTIVE CARE DRUGS WITH FREQUENT DDI ISSUES Stuart Lichtman Medicine, Memorial Sloan Kettering Cancer Center, Commack, USA

The evaluation of medication use in older patients is particularly important due to polypharmacy. Polypharmacy and the issue of potentially inappropriate medication use lead to increase in adverse events in the older, vulnerable population. This can lead to falls, cognitive impairment, and delirium and can compromise treatment. Many of the drugs are metabolized by the cytochrome P450 system. Some of the tyrosine kinase inhibitors used in therapy are also metabolized in this manner which can

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be problematic in treatment decisions and may effect outcome. There are also medications that prolong the QT interval. This includes antineoplastic agents, molecularly targeted drugs and supportive care therapies. These can include narcotics, antiemetic, and antimicrobial drugs. Clinicians need to be aware of these interactions to increase the therapeutic index of treatment. Careful review of patients’ medications and an evaluation of interventions to reduce polypharmacy is clearly indicated. The lecture will discuss these issues. Disclosure of interest: None declared

Disclosure of interest: None declared Keywords: None

S27 IMPLICATIONS OF NUTRITIONAL ISSUES IN THE OLDER CANCER PATIENT Matti Aapro IMO Clinique de Genolier, Genolier, Switzerland

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S26 PROFILING THE DDI ASPECTS OF DRUGS IN PROSTATE CANCER Romano Danesi University Hospital, Pisa, Italy

Drug-drug interactions (DDI) play an important role in clinical practice. Abiraterone (ABI) and enzalutamide (ENZA), are antihormonal agents for the treatment of CRPC and have a distinct metabolic and DDI profile. ABI is a potent inhibitor of CYP1A2 and 2D6. Plasma levels of substrates of these enzymes may be increased when taken with ABI [1]. ABI is metabolized by CYP3A4; strong inhibitors of CYP3A4, including ketoconazole, itraconazole and verapamil, may result in an increase in the plasma levels of ABI. ABI is also an inhibitor of P-glycoprotein (ABCB1); therefore, the plasma levels of substrates of ABCB1 may be increased when taken with ABI [1,2]. Concerning ENZA, the drug is extensively metabolized in the liver by CYP2C8 to N-desmethyl ENZA, an active metabolite with reduced activity with respect to the parent drug, and to a lesser extent by CYP3A4/5. If co-administered with strong inhibitors of CYP2C8, including montelukast, trimethoprim, gemfibrozil and pioglitazone, the starting dose of ENZA should be reduced [1,2]. Strong inducers of CYP2C8 may reduce the effectiveness of ENZA and should be avoided if possible. ENZA is a strong inducer of CYP3A4 and a moderate inducer of CYP2C9 and 2C19 [1,3]. Co-administration of midazolam, triazolam and terfenadine may result in decreased exposure to these drugs [1]. ENZA is a substrate of CYP3A4 and dose adjustment of the drug is not necessary when co-administered with CYP3A4 inhibitors, including grapefruit juice, a well known inhibitor of CYP3A4 metabolism in the intestinal wall [1,3]. ENZA induces uridine 5’-diphospho-glucuronosyltransferase (UGT1A1) in vitro and may decrease the exposure to substrates of this enzyme. Finally, ENZA has both inhibiting and inducing effect on ABCB1 and may inhibit breast cancer resistant protein (ABCG2) and multidrug resistanceassociated protein 2 (MRCP2) in vitro [1]. These effects have not been evaluated in vivo; therefore, their clinical significance is unknown. In conclusion, it is highly advisable to carefully monitor drug treatment in prostate cancer patients as clinically significant drug interactions between anti-hormonal agents may occur and increase the rate of potentially serious adverse drug reactions. References [1] BC Cancer Agency - Cancer Drug Manual. http://www. bccancer.bc.ca (last accessed 26/8/2015) [2] Han CS, et al. Pharmacokinetics, pharmacodynamics and clinical efficacy of abiraterone acetate for treating metastatic castration-resistant prostate cancer. Expert Opin Drug Metab Toxicol 2015;11:967-75 [3] Gibbons JA, et al. Clinical pharmacokinetic studies of enzalutamide. Clin Pharmacokinet 2015 doi:10.1007/s40262-015-0271-5

There is evidence that older persons present varying degrees of malnutrition, with a prevalence of 5–30% in those living by themselves to up to 70% in those residing in protected homes. Elderly patients admitted to acute care centers are reported to be malnourished in 23–60% of the cases about a third are at major nutritional risk. One example of the implication of malnutrition in cancer is related to exercise, vitamin D and calcium deficiencies, leading to osteopenia and osteoporosis, which can be limiting factors in breast and prostate cancer treatment. The prognostic implication of poor nutritional status is also exemplified by the G-8 screening tool, which has several factors related to nutritional issues. Recovery from the stress of surgery and tolerance of some radiation therapy treatments are better in well-nourished patients. This is also true for chemotherapy related toxicity, as indicators of poor nutritional status increase the risk of severe side-effects. Disclosure of interest: None declared Keywords: None

S29 MALNUTRITION, SARCOPENIA AND CACHEXIA IN THE ELDERLY WITH CANCER Antonio Vigano Oncology/Supportive-Palliative Care, McGill University, Montrel, Canada

More than three out of five (63%) cancers are diagnosed in people aged 65 and over (Cancer Research UK 2012)Many of these patients experience malnutrition comprising a combination of starvation (inadequate nutrient intake), sarcopenia (loss of muscle mass associated with loss of strength and or function), and cachexia (presence of systemic inflammation/altered metabolism). Starvation, sarcopenia and cachexia need to be timely identified and graded in order to determine requirements and recommendations for the nutritional approach to the elderly with cancer. Our research has focused on staging both sarcopenia and cachexia. According to the criteria proposed by the European Working Group on Sarcopenia in Older People (EWGSOP), patients (N=136) from the Human Cancer Cachexia Database (HCCD) were classified as: pre-sarcopenic (PS) if they presented only with a low appendicular skeleton muscle index (LASMI) by DXA (Men <7.26 kg/m2; Women <5.45 kg/m2); sarcopenic (S) if they had LASMI plus low muscle strength (LMS) (Men <30 kg; Women <20 kg by Hand Grip Strength) or low physical performance (LPP) (Eastern European Oncology Group Performance Status >2/4) and severely sarcopenic (SS) if they presented with LASMI, LMS and LPPAn holistic approach to the main health determinants of the

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malnourished elderly cancer patient (MECP) is needed. LASMI could not differentiate NS from PS, whereas the presence of LMS or/and LPP in addition to LASMI clearly distinguished both S and SS from other stages for several clinical outcomes. Our data support the notion that the diagnosis of sarcopenia should be based on both body composition and functional parameters in advanced cancer patients. Abnormal biochemistry (C-reactive protein >10 mg/L, white blood cells >11,000/L, serum albumin <32 g/L, haemoglobin <120 g/L in men and <110 g/L in women); decreased food intake; weight loss 0-5% or >5%/in 6 months; decreased performance (ECOG >2) were used to classify patients from the HCCD (N=277) into the following cancer cachexia stages (CCS): non-cachexia (NC), pre-cachexia (PC), cachexia (C) and refractory cachexia (RC). Survival, body composition (muscle and fat mass, body mass index), function (hand grip strength) and several symptoms (fatigue, pain, drowsiness, appetite, nausea and well-being) were significantly different across CCS (p<0.05). The staging of both sarcopenia and cachexia are clinically feasible and represent important elements in the holistic approach to malnutrition in the elderly with cancer. Disclosure of interest: None declared

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and thus multidisciplinary care. Cancers such as locally advanced oropharynx and larynx cancers require concurrent chemoradiation as a preferred alternative to surgery for an organ-preservation approach. The benefit of adding chemotherapy to radiation in patients with these cancers over the age of 70 remains unclear. Longterm head and neck cancer survivors cope with several functional outcome issues related to speech, swallowing, hearing, gastrostomy tube use, and physical function. Older adults may have less robust recovery in physical function compared to other functional domains. Geriatric assessment data in this patient population remain sparse. Key patient selection for intensive multimodal therapy and supportive care during and after such therapy for older adults with head and neck cancer is critical and should require multidisciplnary team-based approach. The Portland VA Medical Center had set up a multidisciplinary head and neck cancer clinic to provide access to all the ncessary care providers in order to assess newly diagnosed veterans and then recommend, implement, and follow through on the treatment plan. A patient case illustrates how having such a multidisciplinary clinic benefitted a vulnerable veteran with locally advanced larynx cancer. Disclosure of interest: None declared Keywords: None

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S30 SUPPORTING THE OLDER WOMAN WITH A GYNAECOLOGICAL MALIGNANCY William Tew Memorial Sloan Kettering Cancer Center (MSKCC) New York, USA

S32 UROTHELIAL/GENITOURINARY CANCER: MANAGING MULTIMODALITY THERAPY Ravindran Kanesvaran National Cancer Centre Singapore, Department of Medical Oncology, Singapore

Ovarian cancer (OC) is the leading cause of mortality among patients with gynecologic malignancies. More than half of all OC occurs in women older than 65. Management of newly diagnosed advanced ovarian cancer (OC) typically starts with the combination of extensive debulking surgery and postoperative platinum and paclitaxel chemotherapy. Careful consideration of the chemotherapy dosing, scheduling, route, and timing (neoadjuvant or postoperative) is essential. To determine the safest and most effective treatment, one should consider a pretreatment geriatric assessment (GA) and close cooperation with the gynecologic surgeon. In this session, we will review the current guidelines and evidence of surgery and chemotherapy in the older woman with ovarian cancer and how to coordinate care within a multidisciplinary team. Disclosure of interest: None declared

Very often urothelial cancer patients require multimodality treatment with the involvement of the surgeon, radiation oncologist and medical oncologist. This approach is more apparent in patients who are keen for bladder preservation, when patients may get all three modalities of treatment upfront. In localized muscle invasive disease, patients may undergo radical cystectomy with urinary diversion. This coupled with other surgical complications of the procedure, may necessitate the use of both physical and psychological supportive care for the patient. The other modalities like radiation and chemotherapy also may cause a variety of toxicities that may require supportive therapy to counter their effects as well. In this talk I will discuss the vital role of supportive care in managing the effects of multimodality therapy in the treatment of urothelial cancers. Disclosure of interest: None declared

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S31 HEAD AND NECK CANCER IN OLDER PATIENTS: THE TEAM APPROACH Ronald Maggiore Oregon and Health Science University, Division of Hematology/ Oncology, Oregon, USA

S33 PRACTICAL ASPECTS OF THE MULTIDISCIPLINARY CARE OF OLDER ADULTS WITH CANCER: CHALLENGES AND PITFALLS Theodora Karnakis Geriatrician at Cancer Institute of São Paulo-ICESP , Faculty of Mediicine of São Paulo University -FMUSP and Hospital Sirio Libanês

Squamous cell carcinomas of the head and neck still affect most adults in their sixties and often require multimodailty treatment

Multidisciplinary teams (MTDs) with the use of Comprehensive Geriatric assessment (CGA) have been incorporated in the practical

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care of elderly cancer patients. Several geriatric oncology service (GOS) try to design the best way to implement the MTDs with the use of CGA. The challenges and pitfalls of a multidisciplinary team must be known for a better care planning for elderly cancer patients. It is necessary to recognize that the care for elderly cancer patients often requires more time in scheduling, comprehensive management, strategies and organization of the multidisciplinary team resources: available resources (staff, space, and time) must be organized according to the reality of the center in which MTDs is implemented 1. Coordinating team: most studies suggest one person should be designed as the clinic coordinator to direct the team members, CGA and facilitate the team communication concerning the interpretation of scores and development of recommendations 2. Expectations of oncologists:Th MTDS should have clear arrangements on who will be referred to CGA team, what the cancer specialist can expect from CGA and the time frame to expect to have reports 3. Expectation of patients: unwillingness to attend extra hospital visits, patients and family can be confused who will be responsible for each specific part of the care plan. The best way to implement a MTDs depends on the resources and organization of the GOS. The impeccable communication of the team and adaptation with the reality of the local population and service have to be the first step to start the job. Further studies will be necessary. Disclosure of interest: None declared Keywords: None

S34 THE NURSE Martine Puts University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Canada

The older adult population is the most heterogeneous in terms of health and function compared to any other age groups. Nurses are often involved in the initial assessments of the person’s health and functioning. Nurses face several challenges in caring for older adults, such as assessing their functioning in the community, how much support they have and need, as well as reviewing how well they understand their treatment plans and are able to follow-up on geriatric- and treatment-related recommendations. Coordinating the care for this patients is particularly important both inside and outside the hospital with regular contact with older adults. Several practical nursing issues and solutions will be discussed. Disclosure of interest: None declared Keywords: None

S35 THE MEDICAL ONCOLOGIST Ronald Maggiore Oregon and Health Science University, Division of Hematology/ Oncology, Oregon, USA

A real patient case is presented as a pragmatic springboard to discuss the role the medical oncologist plays in facilitating

multidisciplinary care for the older adult with cancer. An older veteran with synchronous locally advanced oropharynx cancer and gastric MALT lymphoma with significant geriatric syndromes and psychosocial barriers is reviewed. As the case unfolds, how multidisicplinary care was implemented at the time of diagnosis, with treatment for each cancer, and with the recovery period during the first few months post-treatment. Disclosure of interest: None declared Keywords: None

S36 SUPPORTING THE PATIENT EARLY Gilbert Zulian HUG Geneva University Hospitals, Geneva, Switzerland

Despite improvements seen over the past decades in the management of cancer disorders, patients suffer from unpleasant side effects of diagnostic procedures, surgery, radiotherapy, chemotherapy, hormonotherapy and now immunotherapy, not to mention the financial toxicity. Fatigue, nausea, vomiting, infections, anemia, hair loss, mucositis, skin rash, anxiety, anorexia, depression, sleep troubles are among the most prominent toxicities to expect when facing the cancer. In addition, hospitalisation, social exclusion, familial upheaval and ultimately death stand at the corner of the cancer journey with half of patients still dying as the result of the disease spread. There is thus a medical duty to inform patients about their concerns and to take every measure to protect and maintain the quality of life. And this must start at the begining of the cancer trajectory to help patients’ empowerment. Prevention is better than cure because it can save the labour of being sick was written already 400 years ago. Traditional supportive care have efficiently addressed drug side effects as well as the complications of surgery and of radiation therapy during the curative phase. But what about rehabilitation to get back to the previous role and function or to find another valuable place in the society. Nutritional support, physical exercise, psychological counselling, and financial aid should progressively touch every single citizen. On the other hand, little attention has been paid to determine when the transition between the curative and the palliative phase starts. The palliation of symptoms is not regarded with similar eyes in every part of our world, neither the significance of the illness nor the reality of death. Though the benefits of the integration of a specialized palliative care at diagnosis of an incurable disease, like inoperable or advanced NSCLC, has been demonstrated, patients often remain without such assistance until very late in their life. Less time spent in hospitals, less referals to the emergency department, less anxiety and less depression have been observed in patients under the care of both the cancer specialist and the palliativist. Quality of life is improved and less resources are required when palliative care specialists and cancer specialists work together. It has even been suggested that survival might be increased. And this could be the illustration of the synergistic effect of adding various skills altogether. In conclusion, the sooner the better, it is a question of personal responsibility and an ethical duty. Disclosure of interest: None declared Keywords: None

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S37 RETHINKING CAREGIVING: IMPLICATIONS FOR OLDER ADULTS WITH CANCER WHO WISH TO REMAIN AT HOME Jane Phillips UTS, Centre for Cardiovascular and Chronic Care, Australia

Caregiver’s make a significant contribution to society, with latest estimates suggesting that replacement value of the care provided by Australia’s unpaid caregivers’ has increased to $60.3 billion per year, or more than $1 billion every week. This shift has largely occurred as a result of strategies aimed at reducing health care costs and minimising the numbers of day’s people spend in care. The unintended consequences of this policy change has until recently been largely invisible. However, population ageing is challenging governments, health care organisations and families to reconsider how best to provide informal care in the community. Increasingly the informal caregiver responsibility is falling to people aged 65 years and older and the impact of this role is amplified in the presence of co-existing health problems and/or disability. Many caregivers gradually assumed this complex role without considering the potential impact of this responsibility, especially as the intensity of care increases as the older persons’ health deteriorates. As cancer care professionals we need to be cognisant of the physical, mental and economic repercussions of caregiving. In addition to being mindful of the age of our caregivers, we need to also consider the impact of caring on their free personal time, their changing social roles and the potential for a decline in their physical and mental wellbeing, as well as potential strain on their financial resources. This presentation will explore the current global caregiver demographics, the impact of population ageing on caregiver availability and capacity, the future challenges in supporting this growing army of unpaid helpers. It will also examine opportunities to better address caregivers’ needs through more effective models of care, strengthening social capital and the use of adaptive technology. It will also consider positive public policy initiatives required to sustain the significant contribution made by unpaid caregivers. Disclosure of interest: None declared

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often results in considerable consequences, not just for ageing individuals but also for healthcare system, families and care givers. 75% of cases present with advanced cancer where curative options of treatment are not viable and option is Palliative Care. Average geriatric patients have 4 to 5 comorbid conditions which also call for Palliative Care. Hence Palliative Care is the corner stone of geriatric care in oncology patients. This is to be decided using Comprehensive Geriatric Assessment Score and Comorbidity Score. Hence, these call for therapy to improve Quality of Life through symptom control, and which can convert the Cancer Care with a chronic illness trajectory and may include Palliative Surgery, Palliative Radiotherapy, and Palliative Chemotherapy with Best Supportive Care. The type of care will depend on the Palliative Scores, Longevity, Affordability, Accessibility and Availability. This may not be available to all patients. The care can be done at home as well as in the hospital setting. Per say, science and practice of geriatrics in Developing Countries is still in its nascence. This also is true for Palliative Care. A comprehensive Palliative Care Program in geriatric Oncology is of profound importance. Disclosure of interest: None declared Keywords: None

S39 HOW GENOMIC TOOLS CAN AID DIAGNOSIS AND TREATMENT IN ELDERLY: THE GI EXAMPLE Astrid Lievre Gastroenterology Department, University Hospital Pontchaillou, Rennes, France

The conference will expose the molecular features of colorectal cancers occuring in elderly compared to younger patients and the impact of molecular profile on the management of colorectal cancer, particularly in the adjuvant setting. Disclosure of interest: None declared Keywords: None

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S38 PALLIATIVE CARE OF OLDER ADULTS IN DEVELOPING COUNTRIES Gouri Shankar Bhattacharyya Molecular Oncology Society, Indian Association of Cancer Research

S40 INNOVATIVE TRIAL DESIGN IN OLDER AND FRAIL POPULATIONS Matthew Seymour Prof GI Cancer Medicine & Consultant Medical Oncologist, University of Leeds; NIHR Clinical Research Network Theme Lead; NCRI Clinical Research Director

Developing countries are in epidemiological and demographical transition. The burden of communicable disease is superimposed by non-communicable disease. In fact Cancer accounts for more deaths in Developing Countries than from Tuberculosis, Malaria and AIDS. The tsunami of cancer and greying has hit the developing countries. By 2020, 70% of all cancers will be in developing countries. By 2050, majority of Geriatric people and patients will be living in developing countries. Ageing is highly individualized process is known to be related to changes in physical, cognitive, emotional, socio-economic status. Increasing age is primarily associated with negative changes in these areas (e.g. increased comorbidity, decreased functions and social support). This age associated changes may occur singly or in combination and

Age and medical comorbidity may affect the pharmacokinetics and pharmacodynamics of anticancer agents, as well as the impact that a given level of toxicity may have upon patient wellbeing. Clinical trials of palliative chemotherapy for patients with advanced common solid cancers commonly recruit patients of better general fitness and younger age than the reallife population with the disease. Furthermore their outcome measures, such as PFS, may reflect only poorly or indirectly the net benefit experienced by patients. FOCUS2 was a 460-patient randomised controlled trial in advanced colorectal cancer recruiting only patients considered unsuitable for standard-dose treatment. It included a multifunctional baseline geriatric assessment, used reduced-

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dose chemotherapy and piloted the use of a composite endpoint “Overall Treatment Utility” (OTU) combining cancer control, adverse impacts and patient acceptability. The lessons learned from FOCUS2 have informed a trial programme in gastroesophageal (GO) cancer. First, “321-GO” explored reduction from standard 3-drug therapy to 2 or 1-drug treatment. Now, “GO-2”, an ongoing 500-patient RCT, is exploring the 2-drug regimen at three different dose-levels and again uses OTU as an endpoint. This trial aims to establish optimum dosage bands based each individual’s baseline geriatric assessment, and to set a paradigm for future dose-adapted therapy trials in vulnerable populations. Disclosure of interest: None declared

These immunotherapeutics enhance immune responses against cancer cells but can also lead to inflammatory side effects called immune-related adverse events (irAEs). Such toxicities are distinct from those associated with traditional chemotherapeutic agents or molecularly targeted therapies. Because the use of immunotherapy agents will likely be widely expanded in the near term, it is critical that healthcare practitioners become more familiar with immune-related toxicities. In this presentation, we will discuss about the spectrum of immunotherapy toxicities, their detection, diagnosis and recommendations regarding their evaluation and management. Disclosure of interest: None declared Keywords: None

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S41 IMMUNESCENCE AND CANCER IN OLDER PATIENTS Graham Pawelec Professor, University of Tübingen (1997)

The clear clinical benefits of boosting antitumor immune responses by therapeutic vaccination now being reported, and especially the dramatic results of treatment with immune checkpoint modulators in different tumor types, are unequivocally documenting the power of immunity to control cancer. However, it is appreciated that immunity wanes with age. An unanswered question is to what extent this impacts on immunosurveillance and immunotherapy of cancer and whether immunosenescence compromises not only responses to infectious agents but also to cancer. In elderly people without overt cancer, changes associated with immunosenescence are known to be exacerbated by exposure to chronic antigenic stress throughout life. Maintaining essential immunosurveillance, especially of chronic viral infections, most notably with the ubiquitous herpesvirus, Cytomegalovirus (CMV) requires a large investment of immune resources. This latent virus, like many tumors, constantly interacts with the immune system, cannot be completely eliminated, and results in signs of immune exhaustion. This presentation will explore the possibility that chronic challenge with tumor antigens and CMV antigens in humans may induce similar senescent changes in T cells, how these may be manipulated to improve immune function, and whether the potentially deleterious effects of CMV together with tumor antigens in cancer patients may be additive. Disclosure of interest: None declared Keywords: None

S42 THE DEVELOPMENT OF IMMUNOTHERAPY IN OLDER ADULTS: NEW TREATMENTS, NEW TOXICITIES? Stéphane Champiat Gustave Roussy, Villejuif, France

Anti-PD-1 and PD-L1 antibodies are emerging as promising anticancer therapeutics in multiple cancer subtypes resulting in remarkable and long-lasting clinical responses.

S43 GERIATRIC INTERVENTIONS IN OLDER CANCER PATIENTS: INTERNATIONAL SOCIETY OF GERIATRIC ONCOLOGY (SIOG) RECOMMENDATIONS. Frank Cornélis Medical oncology, Cliniques universitaires Saint-Luc (Université catholique de Louvain), Brussels, Belgium

Introduction: In the general geriatric population, programmes linking a multidimensional geriatric assessment with interventions and follow-up are effective for improving patient condition and outcomes. Objectives: The aim is to review available data concerning geriatric interventions (GI) in cancer patients and to make recommendations for the use of GI in these patients. Methods: The International Society of Geriatric Oncology (SIOG) established a dedicated task force. A list of questions to be answered was set up. A systematic review of the literature was performed. For each question, papers were classified according to the level of evidence following ASCO guidelines. A task force consensus about recommendations was sought using a validated consensus method. Results: Twenty-one articles were selected reporting control trials evaluating the impact of various interventions (geriatric domain-specific interventions, patient education, case management) on various patients’ outcomes (survival, quality of life, domain-specific outcomes). Several studies suggest that some interventions may have a significant impact on the patient condition and outcomes. In particular physical functioning, quality of life and overall survival may be improved. Nevertheless the number of studies is small and the data are heterogeneous. A variety of interventions are evaluated, targeting different geriatric impairments, in different patient populations, with different endpoints, making comparison between studies difficult. Conclusion: GI may have a significant impact on cancer patient condition and outcomes as in the general geriatric population. Appropriate selection of patients, type and time of interventions are probably crucial. However data are too limited and heterogeneous to draw final conclusions and new randomized trials are urgently needed. In the future, methodological challenges will have to be addressed by researchers regarding the design of trials in order to allow better interpretation of data, to determine the actual benefit of interventions in older cancer patients, to select patients who may benefit from interventions and to identify the most relevant outcomes. Taking into account these limitations, the GI task force of SIOG makes recommendations for the implementation of GI in cancer patients and for future research in this field.

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Disclosure of interest: None declared

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S45 GA AND GUIDED INTERVENTION: THE INTERNATIONAL EXPERIENCE Karis Kin-Fong Cheng National University of Singapore

The demands for and the importance of need-based, patient-centred, and geriatric-specific assessment are growing. Accumulating evidence indicates that Geriatric Assessment (GA) that taps domains of health status of particular salience to senior adults plays an important role in the prognosis of senior adult cancer patients and treatment decision-making. Nevertheless, systematic attempts to assess geriatric domains using GA have yet to be widely integrated into routine clinical practice and oncological research. This paper will share the frameworks to facilitate GA, as well as the transformation of nursing and allied health profession to meet the challenges of geriatric assessment and to lead the integration of GA to guide clinical interventions and outcome evaluation towards excellent geriatric oncology care and practice. Disclosure of interest: None declared Keywords: None

S47 GA AND GUIDED INTERVENTION: THE FRENCH MODEL & CHALLENGES OF TELEMEDICINE Olivier Guerin Professeur des Universités-Praticien Hospitalier, Université de Nice Sophia-Antipolis, Nice, France

Functional implementation of best practices for oncogeriatry represents an important step towards elderly patient management suffering from cancer. Assessment, coordination and follow-up are so far, essential steps to demonstrate the benefits of information sharing between numerous healthcare professionals involved in patient medical personalized pathways implementation. This operational implementation is highly facilitated by information systems development which make collaboration easy and fluent for healthcare professionals. Within this framework, telemedicine should strengthen the use of expert advice to facilitate multidisciplinary consultation times. To reinforce the benefits noted by the implementation of oncogeriatry coordination units (UCOG), East PACA UCOG would like to develop a collaborative study with Accelis Company, to increase coordination efficiency processes, to develop healthcare professional’s implication of elderly patients suffering from cancer, and to ease clinical research project development (especially for inclusion follow-up of patients), based on a global and shared database implementation. Disclosure of interest: None declared

S48 RADIOPHARMACEUTICALS IN THE ELDERLY CANCER PATIENT John O. Prior PhD MD, FEBNM, Professor and Head of Nuclear Medicine and Molecular Imaging at Lausanne University Hospital, Switzerland (www.chuv.ch)

On behalf of the SIOG Taskforce on Radiopharmaceuticals in the Elderly Cancer Patient (John O. Prior, Dept of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland; Silke Gillessen, Dept of Oncology/Hematology, Kantonsspital, St Gallen, Switzerland; Manfred Wirth, Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany; William Dale, Section of Geriatrics and Palliative Medicine, University of Chicago, USA; Matti Aapro, Clinique de Genolier, Geneva, Switzerland; and Wim JG Oyen, Department of Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands) Molecular imaging using radiopharmaceuticals has a clear role in visualizing the presence and extent of tumour at diagnosis and in monitoring response to therapy. Such imaging provides prognostic and predictive information relevant to management, e.g. by quantifying active tumour mass using PET/CT. As these techniques require only pharmacologically inactive doses, the age and potential frailty of patients is generally not important. This may be different for therapy involving radionuclides since the potential effect of radiation can impact normal bodily function (e.g. myelosupression). Iodine-131 has been used as a targeted therapy in thyroid cancer for more than half a century, but the field has gained fresh attention following the survival gains achieved with radium-223 (223Ra) in patients with castration-resistant prostate cancer and symptomatic bone metastases. Although cancer prevalence rises steeply with age, the therapeutic use of radiopharmaceuticals in the older cancer patient specifically has received little attention. Declining renal function is not particularly relevant to 223Ra, which is cleared primarily through the gastrointestinal tract. However, most radiopharmaceuticals are cleared renally and dose adjustment may be required. When contemplating their therapeutic use in the elderly, it is also prudent to consider bone marrow reserve. Compared with younger patients there is less, if any, concern about adverse long-term radiation effects such as radiation-induced second cancers. Hence, there may be a case for less stringent regulation of radiopharmaceuticals in older patients. In elderly prostate cancer patients, there may be advantages in therapeutic radionuclides’ ease of use and relative lack of toxicity in comparison with cytotoxic chemotherapy and agents targeting the androgen receptor. The use of both alpha and beta-emitting radiopharmaceuticals raises understandable concerns about the radioprotection of medical staff, care givers and the wider environment. These issues can be managed by current precautions. However, close co-ordination between oncology and nuclear medicine is needed to ensure safe and effective use of this new treatment in prostate cancer and, potentially, in other tumours where bone metastasis is common. Disclosure of interest: None declared Keywords: None