Comparison of first-line (1L) treatment (tx) patterns and overall survival by age at diagnosis among patients with metastatic pancreatic ductal adenocarcinoma (mPDAC).

Abstract

388 Background: Pancreatic cancer is mostly diagnosed in patients (pts) aged ≥ 65 years and the mortality rate is the highest among older adults. As the population ages, it is expected that there will be a significant rise in the number of older pts with mPDAC but guidance regarding their management is limited as these pts are under-represented in clinical trials. The oncological care of older adults in daily practice is challenged by various age-related conditions. Therefore, a better understanding of the real-world population will help in the development of more effective tx strategies. This study describes the proportion of pts with mPDAC who were treated, the types of regimens received, and the associated survival outcomes by age at diagnosis. Methods: Data were extracted for pts diagnosed with mPDAC between Jan 2015 and Mar 2020 from the Flatiron Health database. Pts were stratified into three age groups at diagnosis: <70y, 70-79y, and ≥ 80y. The proportion of pts was evaluated who received 1L tx and the types of regimens received in the metastatic setting. ECOG performance scores (PS) at tx initiation were described. Overall survival (OS) from the start of 1L was estimated using Kaplan-Meier methods. Results: Overall, of the 8,382 pts identified, 71.3% (n=5,973) received tx. Among pts who received tx, 55.5% (n=3,313) were aged <70y at diagnosis, 33.0% (n=1,972) were 70-79y, and 11.5% (n=688) were 80y+. Among those with data available, ECOG PS ≥2 was observed in 15.9% (n=381) of pts <70y, 21.0% (n=309) of pts 70-79y, and 29.9% (n=147) of pts 80y+(p < 0.001). The proportion of pts who received tx decreased with increasing age at diagnosis: 74.9%, 70.9%, and 58.5% for pts aged <70y, 70-79y, and 80y+, respectively. Gemcitabine monotherapy (gem-mono) and gemcitabine + nab-paclitaxel (GNP) accounted for > 70% of regimens prescribed to pts aged 80y+. The median OS (mOS) for patients treated with GNP, gem-mono, FOLFIRINOX, and liposomal irinotecan-based regimens are presented in the table. Conclusions: This study of treatment patterns among pts with mPDAC found that older pts were more likely to have a decreased performance status and are less likely to receive treatment. However, older adults who received systemic therapy had comparable survival outcomes to younger pts treated with a similar regimen. The results of this large descriptive analysis suggest that the treatment strategy of mPDAC should not be based on age but rather on an overall assessment of the performance/functional status and geriatric profile of older pts. [Table: see text]