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

Abstract

Despite an aging population and underrepresentation of elderly patients in clinical trials, studies on elderly patients with metastatic pancreatic cancer are scarce. This study investigated the use of chemotherapy and survival in elderly patients with metastatic pancreatic cancer. From the Netherlands Cancer Registry, all 9407 patients diagnosed with primary metastatic pancreatic adenocarcinoma in 2005-2013 were selected to investigate chemotherapy use and overall survival (OS), using Kaplan-Meier and Cox proportional hazard regression analyses. Over time, chemotherapy use increased in all age groups (<70 years: from 26 to 43%, 70-74 years: 14 to 25%, 75-79 years: 5 to 13%, all P < 0.001, and ≥80 years: 2 to 3% P = 0.56). Median age of 2,180 patients who received chemotherapy was 63 years (range 21-86 years, 1.6% was ≥80 years). In chemotherapy-treated patients, with rising age (<70, 70-74, 75-79, ≥80 years), microscopic tumor verification occurred less frequently (91-88-87-77%, respectively, P = 0.009) and OS diminished (median 25-26-19-16 weeks, P = 0.003). After adjustment for confounding factors, worse survival of treated patients ≥75 years persisted. Despite limited chemotherapy use in elderly age, suggestive of strong selection, elderly patients (≥75 years) who received chemotherapy for metastatic pancreatic cancer exhibited a worse survival compared to younger patients receiving chemotherapy. Cancer Medicine Open Access 2841

Trends in treatment and survival of patients with nonresected, nonmetastatic pancreatic cancer: A population‐based study

“…Also in the subgroup of patients with stage III disease, chemotherapy use in our study (34% in 2012‐2014) was limited compared with population‐based studies in the United States (>50%) . Similar data on chemotherapy use were found in a previous study of our group in patients with metastatic pancreatic cancer …”

“…13,22 Similar data on chemotherapy use were found in a previous study of our group in patients with metastatic pancreatic cancer. 10 Despite a major increase in chemotherapy use in NR-M0 patients under 75 years in the current study, overall survival hardly improved. However, the study period mainly covers the gemcitabine era, chemotherapy use and response rates may simply be too low to show a survival improvement in all NR-M0 pancreatic cancer patients.…”

“…In patients with metastatic disease, population-based studies have shown that the administration of palliative chemotherapy steeply increased in the past decades. 3,9,10 Notably, this increased use of chemotherapy was found in the gemcitabine era, and thus, before the studies on FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) and nab-paclitaxel plus gemcitabine reported favorable results compared with gemcitabine alone. 11,12 No randomized controlled trials have yet been published on these chemotherapy schemes in patients with LAPC.…”

Circulating tumor DNA quantity is related to tumor volume and both predict survival in metastatic pancreatic ductal adenocarcinoma

“…1 On baseline imaging, baseline imaging data were missing for one patient. 2 With or without metastases to other organs. 3 Available for 47 cases.…”

“…1 Around 40% of PDAC patients present with metastatic disease (mPDAC), which is associated with an extremely poor prognosis of two to three months median overall survival (OS). 2 Tools to predict prognosis, personalize treatment and monitor treatment response are urgently needed.…”