Namrata Vijayvergia1, Efrat Dotan2, Karthik Devarajan3, Kamel Hatahet4, Farah Rahman2, Julianna Ricco2, Bianca Lewis2, Sameer Gupta5, Steven J Cohen2. 1. Deparment of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA. Electronic address: namrata.vijayvergia@fccc.edu. 2. Deparment of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA. 3. Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA, USA. 4. Department of General Internal Medicine, Temple University Hospital, Philadelphia, PA, USA. 5. Bryn Mawr Medical Associates, Bryn Mawr, PA, USA.
Abstract
BACKGROUND: Older patients with metastatic pancreatic cancer (mPC) are poorly represented in clinical trials. We compared patterns of care and outcomes of patients with mPC < and >65 yrs (Group 1 and Group 2, respectively) treated at Fox Chase Cancer Center (FCCC) to identify predictors of survival and better understand the treatment approaches. METHODS: Charts of 579 patients with mPC treated at FCCC from 2000 to 2010 were reviewed. Group 1 and Group 2 were compared with respect to baseline, treatment characteristics, and overall survival (OS) after diagnosis of metastatic disease. RESULTS: 299 patients in Group 1 (median age 57) and 280 patients in Group 2 (median age 73) were evaluated. Patients in Group 2 were less likely to receive any chemotherapy for mPC compared to Group 1 (65% vs 75%, p=0.001) and if treated were less likely to receive more than one agent (37% vs 53%, p<0.001). Survival was comparable between the two groups (p=0.16) and Charlson Co-morbidity Index did not emerge as a prognostic factor. Longer OS was associated with higher number of agents used in both groups (p<0.001). Liver metastases conferred worse survival (p=0.02) while lung metastases conferred better survival in both groups (p=0.002). CONCLUSIONS: Older mPC patients are less likely to receive chemotherapy and receive fewer agents yet have similar OS compared to younger patients. OS improves with increasing number of agents, supporting the use of combination chemotherapy in healthy older patients. Our findings encourage enrollment of older patients with mPC with good performance status onto clinical trials with stratification by site of metastases.
BACKGROUND: Older patients with metastatic pancreatic cancer (mPC) are poorly represented in clinical trials. We compared patterns of care and outcomes of patients with mPC < and >65 yrs (Group 1 and Group 2, respectively) treated at Fox Chase Cancer Center (FCCC) to identify predictors of survival and better understand the treatment approaches. METHODS: Charts of 579 patients with mPC treated at FCCC from 2000 to 2010 were reviewed. Group 1 and Group 2 were compared with respect to baseline, treatment characteristics, and overall survival (OS) after diagnosis of metastatic disease. RESULTS: 299 patients in Group 1 (median age 57) and 280 patients in Group 2 (median age 73) were evaluated. Patients in Group 2 were less likely to receive any chemotherapy for mPC compared to Group 1 (65% vs 75%, p=0.001) and if treated were less likely to receive more than one agent (37% vs 53%, p<0.001). Survival was comparable between the two groups (p=0.16) and Charlson Co-morbidity Index did not emerge as a prognostic factor. Longer OS was associated with higher number of agents used in both groups (p<0.001). Liver metastases conferred worse survival (p=0.02) while lung metastases conferred better survival in both groups (p=0.002). CONCLUSIONS: Older mPCpatients are less likely to receive chemotherapy and receive fewer agents yet have similar OS compared to younger patients. OS improves with increasing number of agents, supporting the use of combination chemotherapy in healthy older patients. Our findings encourage enrollment of older patients with mPC with good performance status onto clinical trials with stratification by site of metastases.
Authors: Arti Hurria; Kayo Togawa; Supriya G Mohile; Cynthia Owusu; Heidi D Klepin; Cary P Gross; Stuart M Lichtman; Ajeet Gajra; Smita Bhatia; Vani Katheria; Shira Klapper; Kurt Hansen; Rupal Ramani; Mark Lachs; F Lennie Wong; William P Tew Journal: J Clin Oncol Date: 2011-08-01 Impact factor: 44.544
Authors: Thierry Conroy; Françoise Desseigne; Marc Ychou; Olivier Bouché; Rosine Guimbaud; Yves Bécouarn; Antoine Adenis; Jean-Luc Raoul; Sophie Gourgou-Bourgade; Christelle de la Fouchardière; Jaafar Bennouna; Jean-Baptiste Bachet; Faiza Khemissa-Akouz; Denis Péré-Vergé; Catherine Delbaldo; Eric Assenat; Bruno Chauffert; Pierre Michel; Christine Montoto-Grillot; Michel Ducreux Journal: N Engl J Med Date: 2011-05-12 Impact factor: 91.245
Authors: P Feugier; A Van Hoof; C Sebban; P Solal-Celigny; R Bouabdallah; C Fermé; B Christian; E Lepage; H Tilly; F Morschhauser; P Gaulard; G Salles; A Bosly; C Gisselbrecht; F Reyes; B Coiffier Journal: J Clin Oncol Date: 2005-05-02 Impact factor: 44.544
Authors: Paul Glen; Nigel B Jamieson; Donald C McMillan; Ross Carter; Clem W Imrie; Colin J McKay Journal: Pancreatology Date: 2006-07-13 Impact factor: 3.996
Authors: Daniel D Von Hoff; Thomas Ervin; Francis P Arena; E Gabriela Chiorean; Jeffrey Infante; Malcolm Moore; Thomas Seay; Sergei A Tjulandin; Wen Wee Ma; Mansoor N Saleh; Marion Harris; Michele Reni; Scot Dowden; Daniel Laheru; Nathan Bahary; Ramesh K Ramanathan; Josep Tabernero; Manuel Hidalgo; David Goldstein; Eric Van Cutsem; Xinyu Wei; Jose Iglesias; Markus F Renschler Journal: N Engl J Med Date: 2013-10-16 Impact factor: 91.245
Authors: Matthew T Seymour; Lindsay C Thompson; Harpreet S Wasan; Gary Middleton; Alison E Brewster; Stephen F Shepherd; M Sinead O'Mahony; Timothy S Maughan; Mahesh Parmar; Ruth E Langley Journal: Lancet Date: 2011-05-11 Impact factor: 79.321
Authors: A M Nagrial; D K Chang; N Q Nguyen; A L Johns; L A Chantrill; J L Humphris; V T Chin; J S Samra; A J Gill; M Pajic; M Pinese; E K Colvin; C J Scarlett; A Chou; J G Kench; R L Sutherland; L G Horvath; A V Biankin Journal: Br J Cancer Date: 2013-11-21 Impact factor: 7.640
Authors: William H Ward; Caitlin R Meeker; Elizabeth Handorf; Maureen V Hill; Margret Einarson; R Katherine Alpaugh; Thomas L Holden; Igor Astsaturov; Crystal S Denlinger; Michael J Hall; Sanjay S Reddy; Elin R Sigurdson; Efrat Dotan; Matthew Zibelman; Joshua E Meyer; Jeffrey M Farma; Namrata Vijayvergia Journal: JCO Clin Cancer Inform Date: 2021-01