Treatment, Outcomes, and Clinical Trial Participation in Elderly Patients With Metastatic Pancreas Adenocarcinoma

Abstract

Studies on the treatment patterns and outcomes of elderly patients with metastatic pancreas cancer remain limited. Therefore, an analysis of systemic therapy use, clinical trial participation, and outcomes in elderly patients with metastatic pancreas cancer was performed at our institution. Elderly patients who received systemic therapy had a longer survival compared with those who did not. However, therapeutic clinical trial participation was low and should be encouraged Background Pancreas adenocarcinoma has a median age at diagnosis of 71 years. Limited studies have focused on the treatment of elderly patients with pancreas cancer. Patients and Methods An analysis of systemic therapy use, clinical trial participation, and overall outcomes of 237 patients with metastatic pancreas adenocarcinoma ≥ 75 years of age evaluated at Memorial Sloan-Kettering Cancer Center between 2005 and 2013 was undertaken. Results Median overall survival was 7 months for the entire study population. A total of 197 (83%) patients received systemic therapy, which was significantly associated with longer overall survival (P < .01). No significant difference was detected in survival between age groups 75 to 79, 80 to 84, and ≥ 85 years of age among those who received systemic therapy (P = .49). Seventy-seven (32%) patients participated in a clinical trial of whom 13 (5%) patients were enrolled in a therapeutic trial, including no patients aged ≥ 85 years. Multivariate analysis demonstrated that presence of liver metastases (P < .001), performance status (P < .001), and number of systemic agents (P < .001) were significantly associated with survival. Conclusion Receipt of systemic therapy was associated with longer survival in elderly patients ≥ 75 years of age with metastatic pancreas adenocarcinoma. Therapeutic clinical trial participation among these patients was low and future development of prognostic models for appropriate patient selection is warranted.

Nationwide trends in chemotherapy use and survival of elderly patients with metastatic pancreatic cancer

“…G. M. van der Geest et al Chemotherapy Use in Metastatic Pancreatic Cancer our nationwide study (≥75 years: median 4.0 months) was strikingly worse than the median of 7-8 months in previous mono-institutional cohorts of patients over 75 years of age [11,12]. Our observations are likely related to the nationwide character of our study with a less selective cohort of elderly patients.…”

“…Most previous observational studies only included patients with microscopically confirmed pancreatic cancer [5,11,13,21,22,32]. Although pathologic confirmation of pancreatic cancer prior to chemotherapy is strongly recommended [27,33], one in ten of treated patients in our study started chemotherapy without prior microscopic tumor verification.…”

Neoadjuvant Nab-paclitaxel and Gemcitabine in Borderline Resectable or Locally Advanced Unresectable Pancreatic Adenocarcinoma in Patients Who Are Ineligible for FOLFIRINOX

“…In our cohort, 72% of AG doses had to be reduced, but no patient was taken off chemotherapy due to intolerance despite having patients with ECOG PS up to 3 and ages up to 90. Historically, elderly and/or poor PS patients with PDAC, both of whom represent a clinically significant proportion of real-world patients outside of clinical trial populations, have been excluded from curative-intent strategies (13). Our data suggest that these patients may now have a possibility for potentially curative resection with the use of neoadjuvant AG.…”

SW43‐DOX ± loading onto drug‐eluting bead, a potential new targeted drug delivery platform for systemic and locoregional cancer treatment – An in vitro evaluation

“…curative tumor resection, there is an urgent demand for the development of novel and effective therapies of locally advanced and metastasized tumors. Besides primary liver cancer, the liver is also a frequent location for remote metastases of many tumor types including colorectal and pancreatic carcinoma occurring in the majority of the patients during the course of disease (De Groote and Prenen, 2015;Kotoyan et al, 2012;Li et al, 2015) which is currently still associated with a very poor survival prognosis unless resection or ablation as curative treatment modalities are feasible. Unfortunately, only the minority of patients are suitable candidates for curative treatment of primary and secondary liver tumors with the tumor liver burden considered as the major life-limiting cause in these patients (Bruix and Llovet, 2002;De Groote and Prenen, 2015;Forner et al, 2012;Jarzabek et al, 2011;Kotoyan et al, 2012).…”