3
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      First-line chemotherapy in very elderly patients with metastatic pancreatic cancer: Gemcitabine monotherapy vs combination chemotherapy

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          BACKGROUND

          Combination chemotherapy (gemcitabine plus nab-paclitaxel and FOLFIRINOX) is widely used as the standard first-line treatment for pancreatic cancer. Considering the severe toxicities of combination chemotherapy, gemcitabine monotherapy (G mono) could be used as a first-line treatment in very elderly patients or those with a low Eastern Cooperative Oncology Group status. However, reports on the efficacy of G mono in patients older than 75 years are limited.

          AIM

          To evaluate the efficacy of G mono and combination chemotherapy by comparing their clinical outcomes in very elderly patients with pancreatic cancer.

          METHODS

          We retrospectively analyzed 104 older patients with pancreatic cancer who underwent chemotherapy with G mono ( n = 45) or combination therapy ( n = 59) as a first-line treatment between 2011 and 2019. All patients were histologically diagnosed with ductal adenocarcinoma. Primary outcomes were progression-free survival and overall survival. We also analyzed subgroups according to age [65-74 years (elderly) and ≥ 75 years (very elderly)]. Propensity score matching was performed to compare the outcomes between the two chemotherapy groups.

          RESULTS

          The baseline characteristics were significantly different between the two chemotherapy groups, especially regarding age, ratio of multiple metastases, tumor burden, and Eastern Cooperative Oncology Group performance status. After propensity score matching, the baseline characteristics were not significantly different between the chemotherapy groups in elderly and very elderly patients. In the elderly patients, the median progression-free survival (62 d vs 206 d, P = 0.000) and overall survival (102 d vs 302 d, P = 0.000) were longer in the combination chemotherapy group. However, in the very elderly patients, the median progression-free survival (147 d and 174 d, respectively, P = 0.796) and overall survival (227 d and 211 d, respectively, P = 0.739) were comparable between the G mono and combination chemotherapy groups. Adverse events occurred more frequently in the combination chemotherapy group than in the G mono group, especially thromboembolism (G mono vs nab-paclitaxel vs FOLFIRINOX; 8.9% vs 5.9% vs 28%, P = 0.041), neutropenia (40.0% vs 76.5% vs 84.0%, P = 0.000), and neuropathy (0% vs 61.8% vs 28.0%, P = 0.006).

          CONCLUSION

          In elderly patients, combination therapy is more effective than G mono. However, G mono is superior for the management of metastatic pancreatic cancer in very elderly patients.

          Related collections

          Most cited references12

          • Record: found
          • Abstract: not found
          • Article: not found

          Redefining the elderly as aged 75 years and older: Proposal from the Joint Committee of Japan Gerontological Society and the Japan Geriatrics Society.

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline.

            To provide evidence-based recommendations to oncologists and others for the treatment of patients with metastatic pancreatic cancer.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Serum CA 19-9 as a Biomarker for Pancreatic Cancer-A Comprehensive Review.

              Pancreatic cancer is an aggressive tumor with a dismal prognosis, biomarkers that can detect tumor in its early stages when it may be amenable to curative resection may improve prognosis. At present, serum CA 19-9 is the only validated tumor marker in widespread clinical use, but precise knowledge of its role in pancreatic cancer diagnosis, staging, determining resectability, response to chemotherapy and prognosis remains limited. A comprehensive search was performed using PubMed with keywords "pancreatic cancer" "tumor markers" "CA 19-9" "diagnosis" "screening" "prognosis" "resectability" and "recurrence". All English language articles pertaining to the role of CA 19-9 in pancreatic cancer were critically analyzed to determine its utility as a biomarker for pancreatic cancer. Serum CA 19-9 is the most extensively studied and clinically useful biomarker for pancreatic cancer. Unfortunately, CA 19-9 serum level evaluation in pancreatic cancer patients is limited by poor sensitivity, false negative results in Lewis negative phenotype (5-10%) and increased false positivity in the presence of obstructive jaundice (10-60%). Serum CA 19-9 level has no role in screening asymptomatic populations, and has a sensitivity and specificity of 79-81% and 82-90% respectively for the diagnosis of pancreatic cancer in symptomatic patients. Pre-operative CA 19-9 serum level provide useful prognostic information as patients with normal CA 19-9 serum levels ( 37 U/ml) (12-15 months). A CA 19-9 serum level of 100 U/ml may suggest unresectablity or metastatic disease. Normalization or a decrease in post-operative CA 19-9 serum levels by ≥20-50% from baseline following surgical resection or chemotherapy is associated with prolonged survival compared to failure of CA 19-9 serum levels to normalize or an increase. Carbohydrate antigen (CA 19-9) is the most extensively studied and validated serum biomarker for the diagnosis of pancreatic cancer in symptomatic patients. The CA 19-9 serum level can provide important information with regards to prognosis, overall survival, and response to chemotherapy as well as predict post-operative recurrence. Non-specific expression in several benign and malignant diseases, false negative results in Lewis negative genotype and an increased false positive results in the presence of obstructive jaundice severely limit the universal applicability of serum CA 19-9 levels in pancreatic cancer management.
                Bookmark

                Author and article information

                Contributors
                Journal
                World J Clin Cases
                WJCC
                World Journal of Clinical Cases
                Baishideng Publishing Group Inc
                2307-8960
                26 September 2020
                26 September 2020
                : 8
                : 18
                : 4022-4033
                Affiliations
                Department of Internal Medicine and Biomedical Research Institute, Division of Gastroenterology, Pusan National University Hospital, Busan 49241, South Korea
                Department of Internal Medicine and Biomedical Research Institute, Division of Gastroenterology, Pusan National University Hospital, Busan 49241, South Korea
                Department of Internal Medicine and Biomedical Research Institute, Division of Hematology-Oncology, Pusan National University Hospital, Busan 49241, South Korea. seol2100@ 123456hanmail.net
                Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
                Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
                Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
                Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
                Author notes

                Author contributions: Seol YM designed the research; Han SY, Lee NK, and Hong SB performed research; Han SY and Seo HI contributed to data analysis; Han SY wrote the paper; Kim DU and Kim S contributed to the critical revision of the paper.

                Supported by The National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) , No. 2018R1C1B5086234.

                Corresponding author: Young Mi Seol, MD, PhD, Assistant Professor, Department of Internal Medicine and Biomedical Research Institute, Division of Hematology-Oncology, Pusan National University Hospital, Gudeok ro 179, Seo-gu, Busan 49241, South Korea. seol2100@ 123456hanmail.net

                Article
                jWJCC.v8.i18.pg4022
                10.12998/wjcc.v8.i18.4022
                7520790
                c16677be-0e0e-4391-854e-8156eff454e9
                ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 27 May 2020
                : 18 June 2020
                : 22 August 2020
                Categories
                Retrospective Cohort Study

                combination chemotherapy,gemcitabine,pancreatic cancer,elderly,ductal carcinoma,adverse drug event

                Comments

                Comment on this article