Background There is no clear consensus on the recommended second-line treatment for patients with metastatic pancreatic cancer who have disease progression following gemcitabine-based therapy. We retrospectively evaluated the clinical outcomes of liposomal irinotecan (nal-IRI) plus fluorouracil/leucovorin (FL) and FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin) in patients who had failed on the first-line gemcitabine-based therapy. Patients and methods From January 2015 to August 2019, 378 patients with MPC who had received nal-IRI/FL ( n = 104) or FOLFIRINOX ( n = 274) as second-line treatment across 11 institutions were included in this retrospective study. Results There were no significant differences in baseline characteristics between groups, except age and first-line regimens. With a median follow-up of 6 months, the median progression-free survival (PFS) was 3.7 months with nal-IRI/FL versus 4.6 months with FOLFIRINOX ( P = 0.44). Median overall survival (OS) was 7.7 months with nal-IRI/FL versus 9.7 months with FOLFRINOX ( P = 0.13). There was no significant difference in PFS and OS between the two regimens in the univariate and multivariate analyses. The subgroup analysis revealed that younger age (<70 years) was associated with better OS with FOLFIRINOX. In contrast, older age (≥70 years) was associated with better survival outcomes with nal-IRI/FL. Adverse events were manageable with both regimens; however, the incidence of grade 3 or higher neutropenia and peripheral neuropathy was higher in patients treated with FOLFIRINOX than with nal-IRI/FL. Conclusions Second-line nal-IRI/FL and FOLFIRINOX showed similar effectiveness outcomes after progression following first-line gemcitabine-based therapy. Age could be the determining factor for choosing the appropriate second-line therapy.

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Introduction: Adjuvant chemotherapy after complete surgical resection is currently the standard of care for patients with stage IB-IIIA (7 th Ed. TNM) non-small-cell lung cancer. The applicability of this treatment to the elderly population however is not completely established. This retrospective study evaluated the indication of adjuvant treatment and the influence of age on survival in patients over 65 years with stage I-III non-small-cell lung cancer. Methods: We analyzed 177 patients with resectable stage I-III non-small-cell lung cancer who underwent standard lung cancer surgery between 2005 and 2019 at A. C. Camargo Cancer Center, São Paulo, Brazil. Patients were divided in two age groups: <65 years-old and 65 years-old years. Indication of chemotherapy by age group and the influence of age on survival were studied. We used descriptive statistics (median and frequencies) to characterize the population. Frequencies were compared by the Pearson's Chisquared or Fisher's exact test. Kaplan-Meier method was used to calculate survival curves. Overall survival (OS) was defined as the time in months from the date of surgery to the date of death by any cause. Survival curves were compared by the log-rank test. Disease-free survival (DFS) was defined as the time in months from the date of surgery to the date of disease relapse, diagnosis of second neoplasia or death by any cause. A p-value<0.05 was considered statistically significant for all tests. Results: 40.7% patients were older than 65 years. Median age at diagnosis was 72 years among the elderly and 55 years in the younger group. 15.8% were stage IB, 23.7% stage II and 21.5% stage IIIA. The majority of patients (55.9%) had ECOG 0 and 65% had a Charlson's comorbidity score of 3 to 5. The elderly had statistically more comorbidities when compared to the young group (40.1% x 64.2%, p¼0.0005). 38.4% of patients received adjuvant chemotherapy after surgery with no statistical difference between the two groups (53.1% x 41.9%, p¼0.12). With a medium follow-up of 48.13 months, OS was significantly shorter in the elderly population (55.5mo x 39.2mo; p¼0.002), nevertheless DFS did not differ significantly between groups (15.6mo x 15.3mo; p¼0.93). Furthermore, when analyzed according to number of comorbidities, OS was significantly shorter in the group with 2 comorbidities (p¼0.04). Conclusion: Age was not employed as the sole criteria to withheld adjuvant chemotherapy in our center. Most of patients had multiple comorbidities and the elderly had considerably more. Despite the lower OS among the elderly, our data showed similar DFS, suggesting there is an excess of death in this group due to non-cancer related causes.