First-line chemotherapy in very elderly patients with metastatic pancreatic cancer: Gemcitabine monotherapy vs combination chemotherapy

Abstract

BACKGROUND Combination chemotherapy (gemcitabine plus nab-paclitaxel and FOLFIRINOX) is widely used as the standard first-line treatment for pancreatic cancer. Considering the severe toxicities of combination chemotherapy, gemcitabine monotherapy (G mono) could be used as a first-line treatment in very elderly patients or those with a low Eastern Cooperative Oncology Group status. However, reports on the efficacy of G mono in patients older than 75 years are limited. AIM To evaluate the efficacy of G mono and combination chemotherapy by comparing their clinical outcomes in very elderly patients with pancreatic cancer. METHODS We retrospectively analyzed 104 older patients with pancreatic cancer who underwent chemotherapy with G mono ( n = 45) or combination therapy ( n = 59) as a first-line treatment between 2011 and 2019. All patients were histologically diagnosed with ductal adenocarcinoma. Primary outcomes were progression-free survival and overall survival. We also analyzed subgroups according to age [65-74 years (elderly) and ≥ 75 years (very elderly)]. Propensity score matching was performed to compare the outcomes between the two chemotherapy groups. RESULTS The baseline characteristics were significantly different between the two chemotherapy groups, especially regarding age, ratio of multiple metastases, tumor burden, and Eastern Cooperative Oncology Group performance status. After propensity score matching, the baseline characteristics were not significantly different between the chemotherapy groups in elderly and very elderly patients. In the elderly patients, the median progression-free survival (62 d vs 206 d, P = 0.000) and overall survival (102 d vs 302 d, P = 0.000) were longer in the combination chemotherapy group. However, in the very elderly patients, the median progression-free survival (147 d and 174 d, respectively, P = 0.796) and overall survival (227 d and 211 d, respectively, P = 0.739) were comparable between the G mono and combination chemotherapy groups. Adverse events occurred more frequently in the combination chemotherapy group than in the G mono group, especially thromboembolism (G mono vs nab-paclitaxel vs FOLFIRINOX; 8.9% vs 5.9% vs 28%, P = 0.041), neutropenia (40.0% vs 76.5% vs 84.0%, P = 0.000), and neuropathy (0% vs 61.8% vs 28.0%, P = 0.006). CONCLUSION In elderly patients, combination therapy is more effective than G mono. However, G mono i...

The Core Mechanism of Yiqi Yangjing Decoction Inhibiting Nonsmall-Cell Lung Cancer

“…First, we analyzed the binding potency of the active components and target proteins by molecular docking. Gemcitabine, a tumor chemotherapy drug whose intracellular metabolites bind to DNA and act primarily in the G1/S phase [ 22 , 23 ], was selected for docking with the core targets. Also, the binding potency data worked as a baseline for positive control.…”

Efficacy and Toxicity of Palliative Chemotherapy in Elderly Patients With Advanced Pancreatic Cancer

“…Despite variations in the definition of "elderly" and the study population across different studies, the findings consistently indicate that no significant difference was found between the elderly and young patients in terms of OS and PFS. 7,[9][10][11][12]14,15,17,[21][22][23] In previous studies, the reported OS for elderly patients treated with nab-paclitaxel plus gemcitabine ranged from 8.5 to 12.0 months, 7,9,11,14,22 whereas for FOLFIRINOX, the reported OS ranged from 11.6 to 13.3 months. 15,21,23 Similarly, the reported PFS for nab-paclitaxel plus gemcitabine ranged from 5.5 to 7.2 months, 7,9,11,14 whereas for FOLFIRINOX, it ranged from 3.7 to 10.6 months.…”

“…16 Furthermore, few studies on elderly patients with PDAC who received FOLFIRINOX or nab-paclitaxel plus gemcitabine in Korea have been conducted. 17,18 Therefore, this study aimed to compare the efficacy and toxicity of FOLFIRINOX and nab-paclitaxel plus gemcitabine in elderly patients with advanced PDAC with that of younger patients.…”

“…Nonetheless, a recent study reported that the percentage of elderly patients receiving chemotherapy was much smaller than that of younger patients (43.4% vs 60.3%, P < 0.001) 16 . Furthermore, few studies on elderly patients with PDAC who received FOLFIRINOX or nab-paclitaxel plus gemcitabine in Korea have been conducted 17,18 . Therefore, this study aimed to compare the efficacy and toxicity of FOLFIRINOX and nab-paclitaxel plus gemcitabine in elderly patients with advanced PDAC with that of younger patients.…”

Chemotherapy for advanced pancreatic cancer in older patients (literature review)

“…Y. Han и соавт. ретроспективно оценили эффективность моно-и комбинированной химиотерапии гемцитабином у 104 пациентов пожилого и старческого возраста [15]. В группе пациентов пожилого возраста медианы ВБП и ОВ были значительно выше при комбинированной химиотерапии, чем при монотерапии гемцитабином.…”