Assessment of the external validity of the National Comprehensive Cancer Network (NCCN) guidelines for pancreatic ductal adenocarcinoma in a population of older patients aged 70 years and older

Rodriquenz, Maria Grazia; Negrete-Najar, Juan Pablo; Sam, Christine; Sehovic, Marina; Extermann, Martine

doi:10.1016/j.jgo.2022.04.015

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…First-choice chemotherapy is the current SOC for patients with advanced PDAC. FOLFIRINOX and the combination of gemcitabine and nab-paclitaxel yield ORRs of 31.6% and 23%, respectively, whereas the ORRs of single-agent gemcitabine or fluoropyrimidines vary from 5%-10% [224] . First-choice combination and single drug therapy show mOS of 8-11 months and six to seven months respectively.…”

Section: Immunotherapy Combined With Other Therapy Formsmentioning

confidence: 99%

Immunotherapy in cancer: Where we are and what the future brings?

Antea,

Kristina,

Miroslav

et al. 2023

Trends Immunother.

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Chemotherapy, radiotherapy, and surgery are recognized as the main treatment modalities for cancer. These therapeutic strategies may be effective in the early stages of the disease but are usually ineffective in advanced stages or when the cancer recurs. Recently, great efforts have been made to understand the complex interaction between the immune system and its surveillance of cancer and to find effective immunotherapies for all stages of cancer. Several types of immunotherapies, including adoptive immunotherapy, cancer vaccines, and immune checkpoint blockades, are receiving considerable attention. The clinical relevance of T lymphocytes and NK cells in combating carcinomas is beyond doubt, but their mechanism of tumor surveillance is far from being fully understood. In this review, much attention has been paid to the complex interplay between T lymphocytes, NK cells, and cancer cells and their role in immunotherapy. Moreover, in this review, we summarized the current data on cancer immunotherapies, especially cancer vaccines, T- and NK cell-based immunotherapies. In addition, we highlighted the role of biomarkers as important indicators of response to immunotherapy, as well as potential problems and solutions related to immunotherapy. Insights into the future of immunotherapy are also presented in this review.

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Section: Immunotherapy Combined With Other Therapy Formsmentioning

confidence: 99%

Immunotherapy in cancer: Where we are and what the future brings?

Antea,

Kristina,

Miroslav

et al. 2023

Trends Immunother.

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“…Older patients with pancreatic ductal adenocarcinoma (PDAC) are underrepresented in clinical trials that support clinical guidelines and establish the most beneficial treatments. External validation of clinical guidelines that recommend surgery in localized tumours and chemotherapy in advanced and metastatic tumours is limited in the older population, especially in treatment with curative intent [ 6 ].…”

Section: The Role Of Comprehensive Geriatric Assessment In Patient Se...mentioning

confidence: 99%

Update on the management of older patients with pancreatic adenocarcinoma: a perspective from medical oncology

Guillot Morales,

Visa,

Brozos Vázquez

et al. 2024

Clin Transl Oncol

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In the context of pancreatic cancer, surgical intervention is typically recommended for localized tumours, whereas chemotherapy is the preferred approach in the advanced and/or metastatic setting. However, pancreatic cancer is closely linked to ageing, with an average diagnosis at 72 years. Paradoxically, despite its increased occurrence among older individuals, this population is often underrepresented in clinical studies, complicating the decision-making process. Age alone should not determine the therapeutic strategy but, given the high comorbidity and mortality of this disease, a comprehensive geriatric assessment (CGA) is necessary to define the best treatment, prevent toxicity, and optimize older patient care. In this review, a group of experts from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica, SEOM), the Spanish Cooperative Group for the Treatment of Digestive Tumours (Grupo Español de Tratamiento de los Tumores Digestivos, TTD), and the Multidisciplinary Spanish Group of Digestive Cancer (Grupo Español Multidisciplinar en Cáncer Digestivo, GEMCAD) have assessed the available scientific evidence and propose a series of recommendations on the management and treatment of the older population with pancreatic cancer.

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“…For patients who cannot tolerate or progress on conventional chemotherapy, very few options remain. Radiation therapy is associated with significant morbidity, especially among the elderly [ 6 ]. Advances in precision medicine for PDCs according to the genetics and molecular biology of this disease are promising approaches to overcome the heterogeneity of different patients and improve survival outcomes for this poorly prognostic disease.…”

Section: Introductionmentioning

confidence: 99%

Durable effect of imatinib and metronomic chemotherapy with capecitabine in pancreatic carcinoma

El-Sukhun¹,

Khalidi²

2023

ecancer

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Background: Pancreatic ductal carcinoma (PDC) is a challenging diagnosis with a particularly poor prognosis, even after curative surgery (median survival: <30 months). The prognosis of borderline resectable pancreatic cancer (BR-PDC) is even worse. We describe a patient with BR-PDC who achieved stable disease with metronomic chemotherapy after refusing surgery.Case presentation: A 75-year-old woman was presented with jaundice and epigastric pain. Imaging confirmed a mass in the pancreatic head encasing the superior mesenteric vein, with obstruction of the pancreatic and bile ducts. After stenting to relieve the obstruction, Fine needle aspiration (FNA) confirmed the diagnosis of PDC. The patient refused surgery and radiation therapy but agreed for chemotherapy. After the second cycle of mFOLFIRINOX -complicated by febrile neutropenia -she refused further IV therapy. Genomic profiling revealed KIT amplification. Therefore, she was started on imatinib with dramatic improvement both clinically and biochemically reflected in carbohydrate antigen 19-9 drop. However, that response was short-lived at 3 months. Therefore, capecitabine was added at a low dose of 1 g bid on an alternate weekly basis. The patient did well and she is currently alive with a stable disease as of 2 years after diagnosis. Conclusion:Metronomic chemotherapy, especially capecitabine added to the targeted therapy, imatinib, is a potentially useful treatment for PDC where no other options are available, especially those harbouring no mutation in the dominant four genes. Indeed, the absence of mutation with KIT amplification could be a potential marker for improved outcomes with targeted and metronomic therapy, which deserves further evaluation in a clinical trial setting.

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Assessment of the external validity of the National Comprehensive Cancer Network (NCCN) guidelines for pancreatic ductal adenocarcinoma in a population of older patients aged 70 years and older

Cited by 3 publications

References 25 publications

Immunotherapy in cancer: Where we are and what the future brings?

Immunotherapy in cancer: Where we are and what the future brings?

Update on the management of older patients with pancreatic adenocarcinoma: a perspective from medical oncology

Durable effect of imatinib and metronomic chemotherapy with capecitabine in pancreatic carcinoma

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