Neoadjuvant therapy for pancreatic cancer in patients older than age 75.

Abstract

287 Background: Multiple treatments in series may be difficult for older patients (pt) to tolerate. We sought to examine the outcomes associated with neoadjuvant therapy in older pt with resectable (R) or borderline resectable (BLR) pancreatic cancer (PC). Methods: Pt ≥75 years (O) with those <75 (Y) with R or BLR PC receiving neoadjuvant therapy from 2008-2012 were identified. Clinicopathologic and treatment data were abstracted. Completion of all therapy was defined as the receipt of neoadjuvant therapy followed by surgical resection. Results: We identified 77 (42.5%) R and 104 (57.5%) BLR pt; 29 (16%) were ≥ 75 years. Higher Charlson Comorbidity Index (CCI) (median CCI 4 vs. 2, p<0.01) and more hospitalizations during neoadjuvant therapy (50% vs. 28%, p=0.04) were associated with O vs. Y pt. Older pt were less likely to complete all therapy as compared to Y pt (72.4 vs. 89.5%, p<0.01). Poor performance status was the most common reason for failure to complete all therapy in O vs. Y pt (17.2% vs. 0.7%; p<0.01). Higher CCI (OR 0.25; 95% CI: 0.08-0.74, p=0.01) and higher clinical stage (OR 0.17; 95%CI: 0.06-0.48, p<0.01) were associated with failure to complete all therapy. Of the 138 pt that completed all therapy, no significant differences in complication rates (15 vs. 15.3%, p=0.33), median length of hospital stay (10 vs. 9 days, p=0.29), 30 day readmission rates (10 vs. 11.9%, p=0.81), or median overall survival (24.3 mo vs. 36.7 mo, p=0.20) were observed between O vs. Y pt. Conclusions: After neoadjuvant therapy, 25% of pt ≥ 75 years of age will not undergo surgical resection. The most common reason for not completing all therapy is a decline in performance status. Whether neoadjuvant therapy improves the selection of older pts who should not undergo an operation or prevents successful resection of pt who may have tolerated an operation is unclear. With evolving paradigms of treatment sequencing, the management of PC pt with advanced age will require further assessment.