Systemic Combination Chemotherapy in Elderly Pancreatic Cancer: a Review

Garcia, Gwenalyn; Odaimi, Marcel

doi:10.1007/s12029-017-9930-0

Cited by 38 publications

(23 citation statements)

References 39 publications

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“…Some studies, including meta-analyses, have been conducted on chemotherapy for patients aged 65 years and older[ 8 , 11 ]. These studies showed that combination chemotherapy was more effective than G mono.…”

Section: Discussionmentioning

confidence: 99%

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

Han

Kim

Seol

et al. 2020

WJCC

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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...

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Section: Discussionmentioning

confidence: 99%

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

Han

Kim

Seol

et al. 2020

WJCC

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“…However, given that pancreatic cancer is mainly a disease of the elderly, current clinical trials have underrepresented this important demographic. Their comorbidities and performance status would render the toxicity profile of FOLIRINOX more potent (66) and therefore unacceptable hence these studies may not be applicable to the majority of patients (67). Thus, selection bias means that cohorts of patients undergoing NAT tend to be younger and fitter than an unselected cohort of patients with BRPC.…”

Section: Survival Treatment and Selection Biasmentioning

confidence: 99%

Determining Optimal Routes to Surgery for Borderline Resectable Venous Pancreatic Cancer—Where Is the Least Harm and Most Benefit?

Pandé

Roberts

2019

Front. Oncol.

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Surgery among patients with borderline resectable pancreatic cancer (BRPC) and venous disease has emerged as a viable strategy to achieve curative treatment. By definition, these patients are at increased risk of a positive resection margin, however, controversy exists with regards to necessity of radical surgery and optimum pathways with no consensus on definitive treatment. A surgery first approach is possible though outcomes vary but patients can have an efficient pathway to surgery, particularly if biliary drainage is avoided which limits overall complications. Neoadjuvant therapy (NAT) is emerging as a widely used strategy to improve oncological outcomes, including resection margin status. However, some patients progress on NAT whilst others suffer major complications whilst elderly patients are unlikely to be offered effective NAT limiting the widespread applicability of this therapy. In this article an overview of the entire pathway is presented along with assimilation of current best evidence to determine optimal routes to surgery for BRPC with venous involvement.

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“…PC affects older patients, and the median age at diagnosis is 70 years (Howlader et al, ). Fit older patients with PC have the same benefits from curative surgery and combination chemotherapy regimens as younger patients (Garcia & Odaimi, ; King et al, ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of Charlson’s Age‐Comorbidity Index and other risk factors in patients with pancreatic cancer

et al. 2020

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Objectives: Few studies have evaluated the impact of risk factors and comorbidity on overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC).The aim was to investigate the prognostic importance of Charlson's age-comorbidity index (CACI) and other risk factors on prognosis in a clinical real-world cohort of PDAC patients. Methods:A total of 1,159 patients with PDAC who had received at least one cycle of adjuvant or palliative chemotherapy were included from the Danish BIOPAC study.We analysed OS according to CACI, tobacco smoking, alcohol intake, performance status (PS), BMI and diabetes. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for OS using Cox proportional hazards regression. Results:At the end of follow-up, 994 (86%) patients had died. The median OS was 298 days for all patients (range 3-3010) and shortest in patients with stage IV. No association with short OS was seen for CACI > 2, diabetes, alcohol abuse, tobacco smoking, hypertension, and high BMI. Multivariate analysis showed that stage (IV vs. I: HR = 9.05, 95% CI 5.17-15.84), PS (2 vs. 0: HR = 3.67, 2.92-4.61) and treatment with angiotensin-converting enzyme inhibitors (yes vs. no: HR = 1.31, 1.06-1.61) were independent negative prognostic factors. Conclusions:We found that CACI, diabetes, tobacco smoking, alcohol abuse, hypertension, and high BMI were not associated with OS in a real-world cohort of patients with PDAC treated with chemotherapy. Only stage and PS were prognostic parameters. K E Y W O R D SAge-Comorbidity Index, BMI, Charlson, diabetes, pancreatic cancer, risk factors, survival S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section.

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Systemic Combination Chemotherapy in Elderly Pancreatic Cancer: a Review

Cited by 38 publications

References 39 publications

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

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

Determining Optimal Routes to Surgery for Borderline Resectable Venous Pancreatic Cancer—Where Is the Least Harm and Most Benefit?

Prognostic impact of Charlson’s Age‐Comorbidity Index and other risk factors in patients with pancreatic cancer

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