Treatment Intensity, not Age, Affects Survival Time of Patients with Advanced Pancreatic Cancer

Abstract

Background and Aims: Despite older-aged individuals accounting for most patients with pancreatic cancer, elderly patients are still underrepresented in the clinical trials. Our study aims to identify treatment differences as well as to analyze survival times in the younger and older patient group.

Methods: We evaluated the data of 97 pancreatic cancer patients (72 <75 years; 25 ≥75 years) receiving palliative chemotherapy. Age, comorbidity, body mass index (BMI), tumor localization, metastases, carbohydrate-antigen 19-9 (CA19-9) value, number and type of chemotherapeutic agents and treatment regimens used, treatment lines, toxicity and survival time were assessed.

Results: The age groups did not differ in their initial conditions (comorbidity, BMI, tumor characteristics). However, treatment intensity of patients ≥ 75 years was lower. Elderly patients received significantly fewer different chemotherapeutic agents and therapeutic regimens, therapy lines and fewer combination chemotherapies. Moreover, elderly patients survived significantly shorter (7.6 vs. 12.7 months, p=0.001). In multivariance analysis, a significant negative influence on survival time was revealed for low therapy intensity (≤2 chemotherapeutics, ≤2 therapy lines), but not for age. In addition, therapy discontinuation and underweight were significantly associated with survival time.

Conclusion: Not age per se but lower therapy intensity leads to a shorter overall survival in the elderly patient group.