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Nagrial AM, Chang DK, Nguyen NQ, Johns AL, Chantrill LA, Humphris JL, Chin VT, Samra JS, Gill AJ, Pajic M, Pinese M, Colvin EK, Scarlett CJ, Chou A, Kench JG, Sutherland RL, Horvath LG, Biankin AV. Adjuvant chemotherapy in elderly patients with pancreatic cancer. Br J Cancer 2014; 110:313-9. [PMID: 24263063 PMCID: PMC3899761 DOI: 10.1038/bjc.2013.722] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/09/2013] [Accepted: 10/21/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Adjuvant chemotherapy improves survival for patients with resected pancreatic cancer. Elderly patients are under-represented in Phase III clinical trials, and as a consequence the efficacy of adjuvant therapy in older patients with pancreatic cancer is not clear. We aimed to assess the use and efficacy of adjuvant chemotherapy in older patients with pancreatic cancer. METHODS We assessed a community cohort of 439 patients with a diagnosis of pancreatic ductal adenocarcinoma who underwent operative resection in centres associated with the Australian Pancreatic Cancer Genome Initiative. RESULTS The median age of the cohort was 67 years. Overall only 47% of all patients received adjuvant therapy. Patients who received adjuvant chemotherapy were predominantly younger, had later stage disease, more lymph node involvement and more evidence of perineural invasion than the group that did not receive adjuvant treatment. Overall, adjuvant chemotherapy was associated with prolonged survival (median 22.1 vs 15.8 months; P<0.0001). Older patients (aged ≥70) were less likely to receive adjuvant chemotherapy (51.5% vs 29.8%; P<0.0001). Older patients had a particularly poor outcome when adjuvant therapy was not delivered (median survival=13.1 months; HR 1.89, 95% CI: 1.27-2.78, P=0.002). CONCLUSION Patients aged ≥70 are less likely to receive adjuvant therapy although it is associated with improved outcome. Increased use of adjuvant therapy in older individuals is encouraged as they constitute a large proportion of patients with pancreatic cancer.
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Affiliation(s)
- A M Nagrial
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - D K Chang
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
- Department of Surgery, Bankstown Hospital, Eldridge Road, Bankstown, Sydney NSW 2200, Australia
- South Western Sydney Clinical School, Faculty of Medicine, University of NSW, Liverpool NSW 2170, Australia
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow G61 1BD, Scotland, UK
| | - N Q Nguyen
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - A L Johns
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - L A Chantrill
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
- Macarthur Cancer Therapy Centre, Campbelltown, NSW 2560, Australia
| | - J L Humphris
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - V T Chin
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - J S Samra
- Department of Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - A J Gill
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW 2006; Australia
| | - M Pajic
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Australian Pancreatic Cancer Genome Initiative
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
- Department of Surgery, Bankstown Hospital, Eldridge Road, Bankstown, Sydney NSW 2200, Australia
- South Western Sydney Clinical School, Faculty of Medicine, University of NSW, Liverpool NSW 2170, Australia
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow G61 1BD, Scotland, UK
- Macarthur Cancer Therapy Centre, Campbelltown, NSW 2560, Australia
- Department of Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW 2006; Australia
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah, NSW 2258, Australia
- Department of Anatomical Pathology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW 2010, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Medical Oncology, Sydney Cancer Centre, Sydney, NSW 2050, Australia
| | - M Pinese
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - E K Colvin
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - C J Scarlett
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah, NSW 2258, Australia
| | - A Chou
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
- Department of Anatomical Pathology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW 2010, Australia
| | - J G Kench
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - R L Sutherland
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - L G Horvath
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
- Department of Medical Oncology, Sydney Cancer Centre, Sydney, NSW 2050, Australia
| | - A V Biankin
- The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
- Department of Surgery, Bankstown Hospital, Eldridge Road, Bankstown, Sydney NSW 2200, Australia
- South Western Sydney Clinical School, Faculty of Medicine, University of NSW, Liverpool NSW 2170, Australia
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow G61 1BD, Scotland, UK
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