Update on the Management of Pancreatic Cancer in Older Adults

Abstract

Pancreatic cancer is more common in older adults, who are underrepresented in clinical trials and frequently under treated. Chronological age alone should not deter clinicians from offering treatment to geriatric patients, as they are a heterogeneous population. Geriatric assessment, frailty assessment tools, and toxicity risk scores help clinicians select appropriate patients for therapy. For resectable disease, surgery can be safe but should be done at a high-volume center. Adjuvant therapy is important; though there remains controversy on the role of radiation, chemotherapy is well studied and efficacious. In locally advanced unresectable disease, chemoradiation or chemotherapy alone is an option. Neoadjuvant therapy improves the chances of resectability in borderline resectable disease. Chemotherapy extends survival in metastatic disease, but treatment goals and risk-benefit ratios have to be clarified. Adequate symptom management and supportive care are important. There are now many new treatment strategies and novel therapies for this disease.

Can Elderly Patients With Pancreatic Cancer Gain Survival Advantages Through More Radical Surgeries? A SEER-Based Analysis

“…Pancreatic cancer is commonly known as "the king of cancers" and is the deadliest cancer in the Chinese cancer registry, with a survival rate of only 7.2% (19). Due to its features (rapid progression and late detection), pancreatic cancer often occurs in the elderly (20,21). With the increasing trend of population aging, the numbers of elderly patients with pancreatic cancer will continue to rise.…”

“…Elderly patients with pancreatic cancer usually have a worse prognostic survival than their younger counterparts due to poor health status or comorbidities (10). Even in elderly patients who are in good physical condition and have few complications, age or cancer-induced cachexia might prevent them from receiving more active treatments (11).…”

Pancreatic cancer: treatment approaches and trends

“…The adenocarcinoma is the most common pancreatic cancer, representing 85% of all cases [15] . Furthermore, the pancreatic adenocarcinoma remains one of the most challenging malignancies with limited therapeutic options and poor prognosis [3] because it is usually diagnosed at an advanced stage [16] .…”

Nanotechnologies in Pancreatic Cancer Therapy

“…Pancreatic cancer (PC) is the 4th common cause of cancer related mortality in the western world and is predicted to become the 2nd leading cause by 2030 [ 1 ]. Despite significant developments in the treatment of other cancer types, the 5-year survival rate for PC (approximately 5%) remains the same.…”

“…Pancreatic adenocarcinoma (PDAC) makes up >90% of PCs [ 2 ] and is the most demanding PC to treat [ 3 ]. PDAC is the only gastrointestinal (GI) malignancy with the lowest survival and with the lowest quality prognosis [ 1 ]. PC is usually diagnosed at a later stage and is strongly resistant to chemo- and radiation therapy [ 4 ] due to lack of distinctive side effects.…”