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CARG Chemotherapy Toxicity Calculator Found Not Valid for Older Patients With Hematologic Malignancies: Ashley Rosko, MD

Ashley Rosko, MD.

Understanding the balance between effective treatments and health-related quality of life is crucial, especially when treating older adults with hematologic malignancies. The Cancer and Aging Research Group (CARG) chemotherapy toxicity calculator has been sufficiently studied and utilized in patients with solid tumors; however, its efficacy in the hematologic malignancy setting was previously unknown.

In a study recently presented at the American Society of Hematology (ASH) 63rd Annual Meeting & Exposition in Atlanta, Georgia, a team of researchers led by Ashley Rosko, MD, Associate Professor of Medicine and Medical Director of Oncogeriatrics at The James Comprehensive Cancer Center, found that the widely used CARG chemotherapy toxicity calculator was associated with overall survival but was not predictive of grade 3 to 5 toxicities in older adults with hematologic malignancies. In this interview, Dr. Rosko shares how these results will be used to further explore the development of chemotherapy toxicity tools for these patients.

Oncology Data Advisor: Can you comment on the results of your study regarding the CARG chemotherapy toxicity calculator for patients with hematologic malignancies?

Ashley Rosko, MD: The CARG chemotherapy toxicity calculator is a set of variables that was developed originally by Dr. Arti Hurria to be able to estimate grade 3 to 5 toxicities in patients with cancer. The original studies that were done were validated in patients with solid tumors but had never been previously analyzed in patients with hematologic malignancies.

In our study, our hypothesis was to see if the CARG chemotherapy toxicity calculator was predictive of grade 3 to 5 toxicities, and it was not predictive of grade 3 to 5 toxicities in our study population. This is important because the CARG chemotoxicity calculator is very widely used but is not applicable to hematologic malignancies, and this is the first study to determine that.

Oncology Data Advisor: How does the CARG chemotherapy toxicity calculator compare with other tools that are used to stratify treatment intensity for older adults?

Dr. Rosko: The CARG chemotherapy toxicity calculator is based upon a geriatric assessment. A geriatric assessment is the standard approach for older adults. It's recommended for all adults aged 65 years and older, and it's founded on the principles of gerontology. There are factors included in the chemotherapy toxicity calculator that are widely applicable to the older adult population: factors and variables such as medication use, functional status, and social status, all of which influence whether or not a patient is going to have adverse events.

Oncology Data Advisor: Is there any more ongoing research to refine chemotherapy toxicity tools for the population of older adults with hematologic malignancies?

Dr. Rosko: This is the first study to really demonstrate that the CARG chemotherapy toxicity calculator is not valid in this study population, and I think that there are a lot of reasons for that. In the CARG chemotherapy toxicity calculator, hemoglobin is a variable. Inherently for patients with blood cancers, they're often anemic, so it's unclear whether or not that variable would need to be changed. In addition, unlike the studies that were done in solid tumors, a lot of the patients that we analyzed are getting novel chemotherapy. It's unclear whether or not the variables that were identified in the first analysis should be applicable to our study population. Our next steps include whether or not we need to reassess if those variables need to be changed or if there are other factors we should include in the calculator.

About Dr. Rosko

Ashley E. Rosko, MD, is an Associate Professor of Medicine and the Medical Director of Oncogeriatrics at The James Comprehensive Cancer Center of The Ohio State University, where she also serves as Co-Director of the Cancer and Aging Resiliency Clinic. Dr. Rosko specializes in the treatment of patients with multiple myeloma and other hematologic malignancies, with particular expertise in geriatric treatment, stem cell transplant, and biologic markers of aging. She is a member of the ASH Scientific Symposium on Hematology and Aging, the Journal of Geriatric Oncology editorial board, and the National Comprehensive Cancer Network (NCCN) Older Adult Oncology panel.

For More Information

Rosko AE, Wall SA, Huang Y, et al (2021). Evaluating the Carg chemotherapy toxicity calculator among older adults newly diagnosed with hematologic malignancy [oral presentation]. 63rd American Society of Hematology Annual Meeting & Exposition. Abstract 1931.

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.


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