First-Line Chemo Beneficial for Elderly Patients With Advanced Pancreatic Cancer

Findings from a mono-institutional retrospective study being presented at the virtual ESMO 23rd World Congress on Gastrointestinal Cancer show elderly advanced pancreatic cancer patients benefitting from first-line chemotherapy.

The purpose of this study, presented by Maria Maratta, MD,Oncologia Medica, Fondazione Policlinico Universitario Agostino, Universita Cattolica del Sacro Cuore, Rome, Italy, and colleagues, was to investigate the role of baseline clinical factors that influence treatment decisions.

“Pancreatic cancer median age at diagnosis is 70 years old. However, elderly patients are underrepresented in randomized clinical trials and chemotherapy efficacy and safety data in this population are limited,” explained Dr Maratta et al.

With this in mind, researchers analyzed patients aged 70 years of age or older receiving first-line chemotherapy for advanced pancreatic cancer between March 2015 and August 2020. The variables collected included gender, age (≥70 and <75 years vs. ≥75 years), baseline ECOG PS (0-1 vs. 2-3); site of the primary tumor (head/uncinate process vs. body/tail); disease stage (locally advanced vs. metastatic); baseline CA 19.9 (< vs. ≥200); chemotherapy regimen; comorbidities (yes vs. no); number of comorbidities (0-1 vs. ≥2).

The primary endpoints were progression-free survival (PFS) and overall survival (OS); univariate and multivariate analyses were performed for both.

Of the 169 patients analyzed, a majority had an ECOG PS of 0-1, were metastatic, and had head/uncinate process primary tumor; 50% of patients have ≥2 comorbidities. The median age was 76 years (70-89). 

The most common form of chemotherapy patients recieved was gemcitabine nab-paclitaxel (60%), other chemotherapy regimes included gemcitabine (28%), FOLFIRINOX (5%), capecitabine (4%), FOLFOX (2%), and FOLFIRI (1%),

A total of 164 patients were evaluable; among these 38, (23%) achieved a partial response, while 58 (35%) achieved stable disease, with a disease control rate of 58%. The median OS was 11 months (median follow-up 21.8 months), and PFS was 6.5 months (median follow-up 19.1 months). In patients with an ECOG PS 3-4, the OS and PFS were 5.5 and 3.3 months, respectively. Meanwhile, patients with an ECOG PS 0-1 was an OS and PDS of 11.3 and 6.7 months, respectively.

According to the multivariate analysis, an ECOG PS 0-1 was linked to improved PFS (P=0.005) and OS (P=0.0084).

“Despite the retrospective nature of the analysis and the limited sample size, we observed that elderly APC pts can benefit from first-line treatment, achieving survival outcomes comparable to the ones reported for younger pts in RCTs,” claimed Dr Maratta and colleagues. 

“In conclusion, elderly pts should not be precluded from active treatment, and careful patient selection, mainly according to baseline ECOG PS, should guide treatment indication,” they added.—Alexandra Graziano

M. Maratta, M. Chiaravalli, M. Bensi, et al. The impact of first-line chemotherapy in elderly patients with advanced pancreatic cancer: A mono-institutional retrospective study. Presented at: the ESMO 23rd World Congress on Gastrointestinal Cancer; June 30-July 3, 2021; virtual. Abstract P-74.