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Adjuvant Chemotherapy for Pancreatic Cancer Patients 80 and Older
Adjuvant chemotherapy after resection of pancreatic cancer — which has evolved from single-agent gemcitabine or single-agent 5-FU to the combination of gemcitabine and capecitabine, and more recently FOLFIRINOX — has become the standard of care, after phase 3 trial results showed a survival benefit associated with this approach (e.g., NEJM JW Oncol Hematol Mar 2019 and N Engl J Med 2018; 379:2395, and NEJM JW Oncol Hematol Apr 2021 and JAMA Oncol 2021; 7:421). However, patients aged 80 and older were underrepresented in the trials, and thus, the benefit for these patients is uncertain.
To further examine the efficacy of adjuvant therapy for older pancreatic cancer patients, investigators now report results of a retrospective cohort study evaluating 2569 patients (age, ≥80) in the U.S. National Cancer Database who underwent resection of pancreatic adenocarcinoma. Of these, 47% received adjuvant therapy and 53% received no adjuvant therapy. Of those who received adjuvant therapy, 74% received a single agent, 18% received combination chemotherapy, and 8% received an unknown regimen. Patients who received adjuvant therapy had a higher pathologic stage (IIB) disease (68% vs. 57%) and were more likely to have a positive margin (24% vs. 20%).
At a median follow-up of 14.4 months, median overall survival (OS; the primary outcome) was longer with adjuvant chemotherapy than with no adjuvant therapy (17.2 vs. 12.7 months; P<0.001), as was 5-year OS (15.2% vs. 10.9%; P<0.001). In a propensity-matched cohort of 1868 patients, median OS continued to be longer with adjuvant chemotherapy (17.2 vs. 12.8 months; P<0.001), as did 5-year OS (14.6% vs. 11.0%; P<0.001).
This important analysis suggests that a survival benefit for adjuvant chemotherapy after resection of pancreatic cancer is maintained in patients over the age of 80, in a cohort largely receiving single-agent adjuvant therapy. Age alone should not be the factor determining the delivery of adjuvant therapy in this disease.
Mehtsun WT et al.
Title: Patterns of adjuvant chemotherapy use and association with survival in adults 80 years and older with pancreatic adenocarcinoma.
Source: JAMA Oncol 2021 Dec 2; [e-pub]. (Abstract/FREE Full Text)