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Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest.

Introduction: In France, 40% of patients diagnosed with lung cancer are ≥70 years old, but these are under-represented in clinical trials. Using data from the French Epidemiological Strategy and Medical Economics (ESME) platform on Lung Cancer (LC), the objective is to provide an overview of the management and the prognosis of older patients with advanced or metastatic non-small cell lung cancer (AM-NSCLC) in a real-world context., Materials and Methods: From the ESME-LC database, we selected patients with AM-NSCLC (stage IIIB, IIIC, and IV), diagnosed between 2015 and 2019, and who received first-line systemic treatment. Demographics, tumour characteristics, and treatment received were described in patients ≥70, and compared to younger ones. Real-world progression-free survival (rwPFS) and overall survival (OS) were evaluated using the multivariable Cox model., Results: Among 10,002 patients with AM-NSCLC, the median age was 64 years, with 2,754 (27.5%) aged ≥70. In comparison with patients <70, older patients were more often male, with worse performance status and more comorbidities, but they were less underweight and more often non-smokers. The proportion of EGFR mutated non-squamous NSCLC was higher in older patients (25.0% vs 12.8%, p < 0.001), particularly among smokers and former smokers (12.7% vs 7.3%, p < 0.001). Among patients ≥70, 76.6% received first-line chemotherapy (including 67.0% treated with a platinum-based doublet), 15.0% received only targeted therapy, and 11.0% received immunotherapy (alone or in combination). Median first-line rwPFS was 5.1 months (95% confidence interval [CI] = [4.8;5.4]) for patients ≥70 and 4.6 months (95%CI = [4.4;4.8]) for patients <70, but age was not associated with rwPFS in multivariable analysis. Median OS was 14.8 months (95%CI = [13.9;16.1]) for patients ≥70 and 16.7 months (95%CI = [15.9;17.5]) for patients <70, with a significant effect of age in multivariable analysis for patients treated with chemotherapy and/or with targeted therapy, but not for patients treated with immunotherapy (alone or in combination with chemotherapy)., Discussion: In this real-world cohort of patients with AM-NSCLC, age was not associated with first-line rwPFS regardless of treatment received, nor with OS for patients receiving immunotherapy. However, OS was significantly shorter for patients aged ≥70 treated with chemotherapy or with targeted therapy alone., Competing Interests: Declaration of Competing Interest Mathilde Cabart reports non-financial support from Janssen, non-financial support from Pfizer, outside the submitted work. Loïc Mourey reports personal fees and non-financial support from Sanofi, personal fees from Astellas, personal fees and non-financial support from Janssen, personal fees and non-financial support from MSD, personal fees and non-financial support from BMS, personal fees and non-financial support from Ipsen, personal fees and non-financial support from Astra-Zeneca, personal fees and non-financial support from Pfizer, personal fees from Merck, outside the submitted work. David Pasquier has nothing to disclose. Sophie Schneider has nothing to disclose. Hervé Léna reports personal fees and non-financial support from Roche, personal fees from Astrazeneca, personal fees and non-financial support from MSD, personal fees and non-financial support from Novartis, personal fees and non-financial support from Takeda, personal fees from BMS, personal fees and non-financial support from Pfizer, non-financial support from Lilly, personal fees and non-financial support from Amgen, outside the submitted work. Nicolas Girard reports grants and personal fees from AstraZeneca, personal fees from Daiichi, grants and personal fees from Roche, grants and personal fees from MSD, grants and personal fees from BMS, grants and personal fees from Pfizer, grants and personal fees from Janssen, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Takeda, grants and personal fees from Novartis, grants and personal fees from Sanofi, outside the submitted work; and Family Member employee of AstraZeneca. Christos Chouaid reports grants, personal fees and non-financial support from AstraZeneca, grants, personal fees and non-financial support from Boehringer Ingelheim, grants, personal fees and non-financial support from GSK, grants, personal fees and non-financial support from Roche, grants, personal fees and non-financial support from Sanofi Aventis, grants, personal fees and non-financial support from BMS, grants, personal fees and non-financial support from MSD, grants, personal fees and non-financial support from Lilly, grants, personal fees and non-financial support from Novartis, grants, personal fees and non-financial support from Pfizer, grants, personal fees and non-financial support from Takeda, grants, personal fees and non-financial support from Bayer, grants, personal fees and non-financial support from Janssen, grants, personal fees and non-financial support from Viatris, grants, personal fees and non-financial support from Chugai, grants, personal fees and non-financial support from Pierre Fabre, grants, personal fees and non-financial support from Amgen, outside the submitted work. Roland Schott reports personal fees and non-financial support from Roche, non-financial support from Takeda, personal fees and non-financial support from AstraZeneca, personal fees and non-financial support from Pfizer, non-financial support from IPSEN, personal fees and non-financial support from BMS, outside the submitted work. Sandrine Hiret reports non-financial support from Roche, non-financial support from Novartis, other from Sanofi, other from Astra Zeneca, other from Takeda, other from BMS, outside the submitted work. Didier Debieuvre has nothing to disclose. Xavier Quantin has nothing to disclose. Anne Madroszyk has nothing to disclose. Pascale Dubray-Longeras reports personal fees from MSD, personal fees from AstraZeneca, personal fees and non-financial support from Takeda, non-financial support from Pfizer, outside the submitted work. Eric Pichon reports personal fees and non-financial support from Takeda, personal fees from AstraZeneca, personal fees from MSD, outside the submitted work. Anne Baranzelli has nothing to disclose. Grégoire Justeau has nothing to disclose. Maurice Pérol reports personal fees and non-financial support from Takeda, personal fees from Janssen, personal fees and non-financial support from AstraZeneca, outside the submitted work. Lise Bosquet has nothing to disclose. Bastien Cabarrou has nothing to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Competing Interests: Declaration of Competing Interest R. Boulahssass: TEVA, Sanofi, BMS, EISA (Advisory Board Member), Hospira, Nutricia, Novartis, Pierre Fabre, Roche, Takeda, Amgen, Lilly. C Baldini: Bicycle Therapeutics, Rising Tide Fundation, GSK and BMS. I. Durand-Zaleski: Amgen, BMS, MSD, Pfizer, Takeda (expertise and training). P. Soubeyran: Celgene, TEVA, GSK (conferences with fees), TEVA, Sandoz, BMS, EISAI, Abbvie (Advisory Board Member). Other authors do not have conflicts of interest to declare.

Geriatric oncology is based on the synergy between several professionals whose common goal is to improve care for older patients with cancer. This requires sharing a common core of knowledge to facilitate collaboration between them. To date, training in geriatric oncology has been limited in scope and difficult to access for caregivers, particularly nurses and healthcare aides. To meet this need, a massive open online course (MOOC), in geriatric oncology has been developed in France. This kind of course aims to provide simultaneous access for a large number of participants and to foster communication with the pedagogical team through discussion forums. The first session of the MOOC, which has been set up in the Occitania region of France, went online nationwide from March 6 to June 23, 2020. Despite the SARS CoV-2 global health crisis, 1020 people subscribed to the first session and 417 (40.9%) were certified at the end of the course. Most are nurses (35.2%) and work outside Occitania (56.3%). A survey revealed a high satisfaction level regarding relevance of lessons (97.9%), pedagogical quality of teaching team (97.9%), knowledge acquisition (93.6%), meeting learners' needs (90.4%) and practical value of the course (88.3%). This preliminary experience demonstrates the ability of this MOOC to spread the culture of geriatric oncology and the educational potential of this new type of online training., Competing Interests: Declaration of Competing Interest No authors report any significant conflicts of interest related to this study., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Pazopanib is a tyrosine kinase inhibitor given at the approved dose of 800 mg orally once daily (OD), but often requiring individual dose adjustment due to toxicity. Limited data is available to guide prescription in older patients especially the unfit according to geriatric assessment., Patients and Methods: VOTRAGE is a 3 + 3 dose-escalation, open-label phase I trial of continuous OD oral administration of pazopanib to evaluate safety, PK and PD data in unfit older patients with advanced solid tumors. The primary objective was to determine the maximum tolerated dose (MTD). PK data were compared with those obtained in younger adult patients in a population PK analysis., Results: Eighteen patients with a median age of 82.5 years (range 75-91) were included in three dosing cohorts (400, 600, and 800 mg daily). Three dose-limiting toxicities (DLT) were observed in five patients at 800 mg and one DLT at 600 mg in six evaluable patients. MTD was defined as level 2 dose (600 mg). Individual oral clearance was not correlated with age. A relationship was observed between the occurrence of DLT and pazopanib plasma exposure. Decreased oral bioavailability of pazopanib when given with proton-pump inhibitors was confirmed in this group of patients., Conclusion: We recommend performing geriatric assessment in patients older than 75 and starting pazopanib at 600 mg per day in unfit older patients. Therapeutic drug monitoring appears very helpful in this population., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: A consensual and operational definition of frailty is necessary in geriatric oncology. While many studies have focused on geriatric syndromes evaluated in the comprehensive geriatric assessment (CGA) to select patients at higher risk of poor outcomes, few have compared CGA data with Fried's phenotype of frailty, the most consensual measurement of frailty in geriatrics. Our objective was to determine a threshold of impaired domains evaluated in CGA associated with Frailty status., Methods: A cross-sectional study including all patients with cancer, evaluated from January 2011 to February 2016 at the Geriatric Frailty Clinic, Toulouse. A CGA was performed evaluating seven geriatric domains. Frailty was measured by Fried's phenotype to classify patients into three groups (robust/pre-frail/frail). We plotted a ROC curve to determine the threshold of impaired domains associated with frailty according to Fried., Results: We included 418 patients aged 82.8 years (range 66-100 years). Thirty-three patients (7.9%) were robust, 155 (37.1%) pre-frail and 230 (55%) frail. There was a significant difference in ADL, IADL, nutrition, cognition and polypharmacy between the three groups (p < .001 for each domain). Frail patients had more impaired geriatric domains on CGA than pre-frail and robust patients (respectively 4.5 ± 1.5, 2.8 ± 1.6 and 2.1 ± 1.2; p < .001). The threshold of 4 impaired geriatric domains associated with Fried's Frailty status was identified (Se 77.39%, Sp 67.55%). Area under the curve was 79.6%., Conclusion: The phenotype of frailty is associated with more impaired geriatric domains and a threshold of 4 altered domains could be used to detect frailty from CGA data., (Copyright © 2019 Elsevier Inc. All rights reserved.)