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Adjuvant chemotherapy in elderly patients with pancreatic cancer

Abstract

Background:Adjuvant chemotherapy improves survival for patients with resected pancreatic cancer. Elderly patients are under-represented in Phase III clinical trials, and as a consequence the efficacy of adjuvant therapy in older patients with pancreatic cancer is not clear. We aimed to assess the use and efficacy of adjuvant chemotherapy in older patients with pancreatic cancer.Methods:We assessed a community cohort of 439 patients with a diagnosis of pancreatic ductal adenocarcinoma who underwent operative resection in centres associated with the Australian Pancreatic Cancer Genome Initiative.Results:The median age of the cohort was 67 years. Overall only 47% of all patients received adjuvant therapy. Patients who received adjuvant chemotherapy were predominantly younger, had later stage disease, more lymph node involvement and more evidence of perineural invasion than the group that did not receive adjuvant treatment. Overall, adjuvant chemotherapy was associated with prolonged survival (median 22.1 vs 15.8 months; P<0.0001). Older patients (aged >/=70) were less likely to receive adjuvant chemotherapy (51.5% vs 29.8%; P<0.0001). Older patients had a particularly poor outcome when adjuvant therapy was not delivered (median survival=13.1 months; HR 1.89, 95% CI: 1.27-2.78, P=0.002).Conclusion:Patients aged >/=70 are less likely to receive adjuvant therapy although it is associated with improved outcome. Increased use of adjuvant therapy in older individuals is encouraged as they constitute a large proportion of patients with pancreatic cancer.British Journal of Cancer advance online publication, 21 November 2013; doi:10.1038/bjc.2013.722 www.bjcancer.com.

Type Journal
Authors Nagrial, A. M.; Chang, D. K.; Nguyen, N. Q.; Johns, A. L.; Chantrill, L. A.; Humphris, J. L.; Chin, V. T.; Samra, J. S.; Gill, A. J.; Pajic, M.; Australian Pancreatic Cancer Genome, Initiative; Pinese, M.; Colvin, E. K.; Scarlett, C. J.; Chou, A.; Kench, J. G.; Sutherland, R. L.; Horvath, L. G.; Biankin, A. V.
Garvan Authors Dr Adnan Nagrial , Amber Johns , Dr Angela Chou , A/Prof Anthony Gill , Prof James Kench , Dr Jeremy Humphris , A/Prof Lisa Horvath , Dr Lorraine Chantrill , Dr Marina Pajic , Dr Mark Pinese , Venessa Chin
Publisher Name BRITISH JOURNAL OF CANCER
Published Date 2014-01-01 00:00:00
Published Volume 10
Published Issue 2
Published Pages 313-9
URL http://www.ncbi.nlm.nih.gov/pubmed/24263063
Status Published In-print
OpenAccess Link https://publications.gimr.garvan.org.au/download.php?11485_12481/13_Nagrial_bjc_.pdf