Overall Survival and Prognostic Factors among Older Patients with Metastatic Pancreatic Cancer: A Retrospective Analysis Using a Hospital Database.

Catherine Conti,Anaïs Charles-Nelson,Frédéric Pamoukdjian,Elena Paillaud,Johanne Poisson,Sandrine Katsahian,Soraya Mebarki,Gilles Manceau,Julien Taieb,Bastien Rance,Thomas Aparicio

doi:10.3390/cancers14051105

Abstract

Simple SummaryThe benefits of standard treatments in metastatic pancreatic cancer (mPC) in terms of overall survival (OS) remain to date unclear, especially after 70 years. Alongside geriatric and oncologic parameters, we showed that the gemcitabine + nab-paclitaxel regimen and anti-diabetic therapy were significantly associated with a better OS, while impaired functional status, the liver metastases and high neutrophil count were associated with a worse OS in older adults with mPC. We confirm the feasibility and efficacy of chemotherapy in older adults with mPC.Pre-therapeutic factors associated with overall survival (OS) among older patients ≥70 years with metastatic pancreatic cancer (mPC) are not known. This was a retrospective single-centre cohort study in Paris including 159 consecutive older patients with mPC between 2000 and 2018. Alongside geriatric parameters, specific comorbidities, cancer-related data and chemotherapy regimens were retrieved. Cox multivariate models were run to assess predictors for OS. The median age was 80 years, 52% were women, 21.5% had diabetes, and 48% had pancreatic head cancer and 72% liver metastases. 62% of the patients (n = 99) received chemotherapy, among which the gemcitabine + nab-paclitaxel (GnP) regimen was the most frequent (72%). Median OS [95%CI] was 7.40 [5.60–10.0] and 1.40 [0.90–2.20] months respectively for patients with and without chemotherapy. The GnP regimen (aHR [95%CI] = 0.47 [0.25–0.89], p = 0.02) and diabetes (aHR = 0.44 [0.24–0.77], p = 0.004) (or anti-diabetic therapy) were multivariate protective factors for death, while ECOG-PS, liver metastases, and the neutrophil cell count were multivariate risk factors for death. In the chemotherapy group, ECOG-PS, number of metastatic sites and the GnP remained significantly associated with OS. Our study confirms the feasibility and efficacy of chemotherapy and the protective effects of diabetes among older patients with mPC.

Highlights

With a median age of 69 years and 73 years at diagnosis for men and women respectively, pancreatic cancer is a disease of the elderly
We found that dependency (ADL and Eastern Cooperative Oncology Group Performance Status (ECOG-PS)), liver metastasis, high neutrophil cell count and diabetes were independent pre-therapeutic factors associated with overall survival (OS)
In a stratified analysis of patients with chemotherapy, ECOG-PS, the number of metastatic sites and the gemcitabine + nab-paclitaxel (GnP) regimen remained significantly associated with OS

Summary

Introduction

With a median age of 69 years and 73 years at diagnosis for men and women respectively, pancreatic cancer is a disease of the elderly. In 2011, compared to gemcitabine alone, the PRODIGE-4/ACCORD11 clinical trial showed the superiority of the FOLFIRINOX regimen (combining 5- fluorouracil + leucovorin + oxaliplatin + irinotecan) as first-line treatment for overall survival in mPC (11.1 months vs 6.8 months; HR = 0.57, p < 0.001) [3]. Compared to gemcitabine alone, the MPACT clinical trial [4] in 2013 showed the superiority of a regimen combining gemcitabine + nab-paclitaxel (GnP) first line for overall survival (8.5 months vs 6.7 months; HR = 0.72, p < 0.001). These two regimens are considered the standard care for mPC. Older adults ≥70 years were not represented in these two trials

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