ASCO 2013: For Patients with Metastatic Pancreatic Cancer, Both Treatment and Survival Decrease with Advanced Age


Key Points

  • Older patients were less likely to receive chemotherapy compared with younger patients (79% vs 92%), and if treated were less likely to receive treatment with more than one agent (34% vs 52%).
  • In recent years, more aggressive chemotherapy regimens have improved outcomes for patients. Researchers seek to determine whether these aggressive treatments might help the older patient population.
  • Future studies will incorporate the standard ways of assessing elderly patients and the evaluation of novel biomarkers of aging such as telomere length.

A new study by researchers Fox Chase Cancer Center has identified a disconnect between clinical trials that look at new treatments for metastatic pancreatic cancer and the patient population most likely to be diagnosed with the disease. Clinical trials typically enroll, and base their findings on, patients in their 50s and 60s, but the median age at diagnosis is 72. The study (Abstract 9546) will be presented at the 2013 ASCO Annual Meeting in Chicago on Monday, June 3.

“We extrapolate our data from studies on younger patients to older patients, but they are different patients, and may have different biology of the disease,” says Namrata Vijayvergia, MD, a fellow in the Department of Medical Oncology at Fox Chase. Dr. Vijayvergia and her colleagues recently found that older patients are less likely to undergo chemotherapy treatment and have a shorter overall survival.

Study Details

As a first step toward better understanding the geriatric form of the disease, the team analyzed medical records of 277 patients treated for metastatic pancreatic cancer at Fox Chase. Out of that group, 155 patients were 65 years old or younger; the other 122 were older than 65. The groups were balanced by sex, cancer stage, and metastatic sites.

Younger patients were more likely to receive chemotherapy, and lived, on average, 1 month longer than older patients (6 months vs 5 months), the researchers reported. Ninety-two percent of the younger patients received chemotherapy, compared with 79% of older patients. Only 34% of the older patients who underwent chemotherapy received treatment with more than one agent, compared with 52% of the younger patients. Among younger patients, those with lung metastases lived longer than average (10 months vs 6 months), and those with liver metastases had decreased survival.

Dr. Vijayvergia described the study as a “stepping stone” toward knowing whether pancreatic cancer in older patients—those closer to the median diagnostic age of 72—has a different biology than the disease diagnosed in younger patients.

New Approaches Needed for Asssessing Older Patients

“We started this study really to take a look at our own experience in terms of treating elderly patients with metastatic pancreatic cancer,” said Steven J. Cohen, MD, Medical Director of Medical Oncology at Fox Chase Cancer Center Partners and principal investigator on the study.

In the past, he said, knowing more about the older pancreatic cancer patient population wouldn't have made much of a difference, as chemotherapy treatment options were limited. The standard chemotherapy treatment was gemcitabine. But in recent years, researchers have developed more aggressive chemotherapy regimens—many still including gemcitabine—that have improved outcomes. According to Dr. Cohen, the time has come to determine whether these more aggressive regimens will help an older patient population.

“We see that the elderly are not receiving as aggressive care as younger patients,” said Efrat Dotan, MD, a medical oncologist at Fox Chase who specializes in geriatric oncology and is working with Drs. Cohen and Vijayvergia on the study. “This raises an interesting question: Is this a function of the fact that the elderly can't tolerate treatment, or does this reflect a bias on the part of practitioners who do not want to treat elderly patients with aggressive chemotherapy?”

Dr. Dotan noted that future studies will incorporate not only the standard ways of assessing elderly patients, but also evaluation of novel biomarkers of aging such as telomere length. Shorter telomeres have been linked to increased cancer incidence and risk of death. This biomarker is currently being evaluated as an assessment tool for older patients with pancreatic and colorectal cancer.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.