Chemotherapy in the elderly patients with advanced pancreatic cancer

Abstract

Introduction: FOLFIRINOX or AG-based chemotherapy is widely accepted as the firstline treatment for patients with pancreatic cancer. Although these regimens present higher response rate and prolonged survival time, it was not well administered in elderly patients by clinicians due to adverse events. More clinical data about the therapeutic response and tolerability of elderly patents (over 70 years old) to FOLFIRINOX or AG are strongly required. Method: In our study, 197 patients with advanced pancreatic cancer (127 metastatic pancreatic cancer patients (MPC) and 70 locally advanced pancreatic cancer patients (LAPC)) were treated using modified-FOLFIRINOX (no Fluorouracil bolus, 85% Oxaliplatin and 75% Irinotecan) or AG between April 2014 and March 2019 in our department. 150 of them were restaged after chemotherapy. The objective response rate (ORR), disease control rate (DCR) and adverse events were measured. Patients were followed up every 3 months, progression free survival (PFS) and overall survival (OS) were calculated. Result: The ORR is 36.7% (11/30) in the elderly patients, which was similar to that in other patients (35.8% (43/120)). The median OS and PFS are 14.1 months and 10.8 months respectively in elderly patients while 12.7 months and 9.8 months in younger patients, no statistical significance was observed between these groups. However, older patients suffered a higher incidence of severe adverse events (50% vs. 26.7%). After given supportive treatments against adverse events, the tolerability of elderly patients were acceptable. Conclusion: These data might provide guidance for chemotherapy use in elderly patients with advanced pancreatic cancer. Age is not a key factor that affects the outcome of chemotherapy, but the supportive treatments are extremely important for elderly patients during the treatment.