OBJECTIVES: Survival benefit of combination over single-agent chemotherapy for metastatic pancreatic ductal adenocarcinoma (PDAC) was demonstrated in younger patients in clinical trials. The authors aimed to evaluate whether this survival benefit of combination chemotherapy is present in elderly patients with metastatic PDAC. MATERIALS AND METHODS: The authors identified elderly patients (age 65 y or older) with stage IV PDAC and extracted available clinical information from a prospectively maintained institutional pancreatic cancer registry from 2007 to 2016. The primary endpoint was overall survival. Cox proportional hazards regression was used for multivariable survival analyses. Survival outcomes for the entire cohort and by age group I (elderly, 65 to 75 y) and age group II (very elderly, older than 75 y) were assessed. RESULTS: A total of 606 patients were included with a median age of 73.8 years. Among them, 239 patients (39%) received combination chemotherapy and 152 patients (25.1%) received single-agent chemotherapy as first-line treatment. Combination chemotherapy was associated with significantly longer median overall survival compared with single-agent chemotherapy (10.9 vs. 7.5 mo, P<0.001) with hazard ratio 0.62 (95% confidence interval, 0.47-0.81; P=0.001) after adjusting for age, sex, comorbidity, Eastern Cooperative Oncology Group (ECOG) performance status, and carbohydrate antigen 19-9 level. Analyses by age groups indicated that very elderly patients (age group II) benefited from combination chemotherapy compared with single-agent chemotherapy with hazard ratio 0.56 (95% confidence interval, 0.31-1; P=0.049), comparable with the age group I (Page-treatment interaction=0.81). CONCLUSION: Elderly patients, even those older than 75 years, with metastatic PDAC benefited from combination chemotherapy.
OBJECTIVES: Survival benefit of combination over single-agent chemotherapy for metastatic pancreatic ductal adenocarcinoma (PDAC) was demonstrated in younger patients in clinical trials. The authors aimed to evaluate whether this survival benefit of combination chemotherapy is present in elderly patients with metastatic PDAC. MATERIALS AND METHODS: The authors identified elderly patients (age 65 y or older) with stage IV PDAC and extracted available clinical information from a prospectively maintained institutional pancreatic cancer registry from 2007 to 2016. The primary endpoint was overall survival. Cox proportional hazards regression was used for multivariable survival analyses. Survival outcomes for the entire cohort and by age group I (elderly, 65 to 75 y) and age group II (very elderly, older than 75 y) were assessed. RESULTS: A total of 606 patients were included with a median age of 73.8 years. Among them, 239 patients (39%) received combination chemotherapy and 152 patients (25.1%) received single-agent chemotherapy as first-line treatment. Combination chemotherapy was associated with significantly longer median overall survival compared with single-agent chemotherapy (10.9 vs. 7.5 mo, P<0.001) with hazard ratio 0.62 (95% confidence interval, 0.47-0.81; P=0.001) after adjusting for age, sex, comorbidity, Eastern Cooperative Oncology Group (ECOG) performance status, and carbohydrate antigen 19-9 level. Analyses by age groups indicated that very elderly patients (age group II) benefited from combination chemotherapy compared with single-agent chemotherapy with hazard ratio 0.56 (95% confidence interval, 0.31-1; P=0.049), comparable with the age group I (Page-treatment interaction=0.81). CONCLUSION: Elderly patients, even those older than 75 years, with metastatic PDAC benefited from combination chemotherapy.
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: Chunling Hu; Steven N Hart; Eric C Polley; Rohan Gnanaolivu; Hermela Shimelis; Kun Y Lee; Jenna Lilyquist; Jie Na; Raymond Moore; Samuel O Antwi; William R Bamlet; Kari G Chaffee; John DiCarlo; Zhong Wu; Raed Samara; Pashtoon M Kasi; Robert R McWilliams; Gloria M Petersen; Fergus J Couch Journal: JAMA Date: 2018-06-19 Impact factor: 56.272
Authors: P N Lara; R Higdon; N Lim; K Kwan; M Tanaka; D H Lau; T Wun; J Welborn; F J Meyers; S Christensen; R O'Donnell; C Richman; S A Scudder; J Tuscano; D R Gandara; K S Lam Journal: J Clin Oncol Date: 2001-03-15 Impact factor: 44.544
Authors: Malcolm J Moore; David Goldstein; John Hamm; Arie Figer; Joel R Hecht; Steven Gallinger; Heather J Au; Pawel Murawa; David Walde; Robert A Wolff; Daniel Campos; Robert Lim; Keyue Ding; Gary Clark; Theodora Voskoglou-Nomikos; Mieke Ptasynski; Wendy Parulekar Journal: J Clin Oncol Date: 2007-04-23 Impact factor: 44.544
Authors: Lydia G M van der Geest; Nadia Haj Mohammad; Marc G H Besselink; Valery E P P Lemmens; Johanneke E A Portielje; Hanneke W M van Laarhoven; J Hanneke W Wilmink Journal: Cancer Med Date: 2017-10-16 Impact factor: 4.452