Second-line chemotherapy in elderly patients with advanced pancreatic cancer: A mono-institutional retrospective experience.

Abstract

606 Background: Only few randomized clinical trials have been conducted for second line therapy in advanced pancreatic cancer (APC). In these studies, elderly patients are poorly represented, even if the median age at diagnosis of APC is increasing; therefore, limited efficacy and safety data are available. Here, we present a retrospective monocentric analysis of second line chemotherapy in elderly patients treated at our Hospital. Methods: This study included patients with APC and aged>70 years old receiving a second-line chemotherapy for APC at our institution from March 2015 to August 2020. The primary endpoints were progression-free survival to second line (PFS2) and overall survival (OS); the secondary endpoint was safety. The Kaplan–Meier method was used to estimate efficacy outcome; log-rank test and Cox-regression model were used to compare the differences, considering a statistically significant p value < 0.05. Results: 169 pts affected with APC received first-line chemotherapy and 61 of them (36%) received second-line therapy. The median age at diagnosis was 74 Years (70-83), 31 (50%) were female; ECOG PS was 0-1 in 44 pts (59%), 41% had at least 2 comorbidities. The regimens of chemotherapy used were: mFOLFOX (28; 46%), Gemcitabine (11; 18%), Capecitabine (15; 24.6%), FOLFIRI (6; 9.8%), mFOLFIRINOX (1; 1.6%). 4 pts (6.6%) had a partial response and 22 (36.1%) had a stable disease, with a disease control rate of 42.7%. The median follow-up was 22.8 months; median PFS2 was 4.5 months (IC 95%: 2.5-6.5) and median OS was 15.4 months (IC 95%: 7.2-23.6). At the univariable analysis, there was a statistically significant difference in mPFS2 according to ECOG PS (0-1 vs 2: 5.3 [IC 95%: 3.5-7.0] vs 2.2 [IC 95%: 1.2-5.4] months; p 0.02) and number of metastatic sites at the beginning of second line therapy (1 vs 2 or more: 5.8 [IC 95%: 4.8-6.7] vs 3.4 [IC 95%: 3.1-3.8] months; p 0.006). At the multivariable analysis, both number of metastatic sites and ECOG PS were confirmed associated with mPFS2. Number of metastatic sites and ECOG PS were both also associated with mOS. No unexpected adverse events were reported, and no patients had to interrupt treatment due to toxicity. Conclusions: In our experience, only about a third of elderly pts with APC received second-line therapy; in these patients, ECOG PS, disease’s burden and the response to therapy are all positive prognostic factors. With regard to the safety profile, older age does not seem to negatively increase serious toxicities. In conclusion, elderly pts should not be precluded from an active treatment (also in later lines setting) and careful patients selection should guide treatment indication.