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Erschienen in: Cancer Chemotherapy and Pharmacology 3/2019

22.06.2019 | Original Article

The efficacy and safety of nab paclitaxel plus gemcitabine in elderly patients over 75 years with unresectable pancreatic cancer compared with younger patients

verfasst von: Utako Ishimoto, Akiyoshi Kinoshita, Yuki Hirose, Keiko Shibata, Ayako Ishii, Ryo Shoji, Takeharu Yokota, Akira Iwaku, Yusuke Mizuno, Kazuhiko Koike, Masayuki Saruta

Erschienen in: Cancer Chemotherapy and Pharmacology | Ausgabe 3/2019

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Abstract

Purpose

To evaluate the efficacy and safety of nab paclitaxel (nab-P) plus gemcitabine (GEM) in elderly patients ≥ 75 years old with unresectable pancreatic cancer (PC) compared with younger patients.

Methods

The data of 27 unresectable PC patients treated with nab-P plus GEM as first-line chemotherapy were retrospectively analyzed. The patients were divided into two groups according to their age at inclusion: an elderly group (9 patients ≥ 75 years old) and a younger group (18 patients <75 years old). We compared the disease control rate, median overall survival (OS), and adverse events (AEs) between the two groups. Predictive factors for the OS were also evaluated.

Results

The clinical characteristics of patients of the two groups were not significantly different except for the age. The respective values for the disease control rate (66.7% vs. 77.8%, P = 0.542) and median OS (277 days vs. 312 days, P = 0.722) were also not significantly different between the elderly and younger group, although the relative dose intensity of GEM/nab-P in the elderly group (56.6%/53.1%) was significantly lower than that in the younger group (67.3%/63.1%) (P = 0.016/0.04). The absence of biliary drainage and CEA ≥ 6.5 were found to be poor prognostic factors in a multivariate analysis. The most common grade ≥ 3 AE was neutropenia (44% in both groups). No significant differences in the frequency of all AEs were observed between the two groups.

Conclusions

Nab-P plus GEM appears effective and well-tolerated for elderly patients ≥ 75 years old with unresectable PC.
Literatur
5.
Zurück zum Zitat Burris HA 3rd et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15(6):2403–2413CrossRefPubMed Burris HA 3rd et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15(6):2403–2413CrossRefPubMed
6.
Zurück zum Zitat Von Hoff DD et al (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369(18):1691–1703CrossRef Von Hoff DD et al (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369(18):1691–1703CrossRef
7.
Zurück zum Zitat Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst 92:205–216CrossRefPubMed Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst 92:205–216CrossRefPubMed
8.
Zurück zum Zitat U.S. Department of Health and Human Services. National Institutes of Health. National Cancer Institute (2009) Common Toxicity Criteria for Adverse Events (version 4) U.S. Department of Health and Human Services. National Institutes of Health. National Cancer Institute (2009) Common Toxicity Criteria for Adverse Events (version 4)
9.
Zurück zum Zitat Von Hoff DD, Ervin T, Arena FP et al (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369:1691–1703CrossRef Von Hoff DD, Ervin T, Arena FP et al (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369:1691–1703CrossRef
10.
Zurück zum Zitat Kuroda T, Kumagi T, Yokota T et al (2017) Efficacy of chemotherapy in elderly patients with unresectable pancreatic cancer: a multicenter review of 895 patients. BMC Gastroenterol 17:66CrossRefPubMedPubMedCentral Kuroda T, Kumagi T, Yokota T et al (2017) Efficacy of chemotherapy in elderly patients with unresectable pancreatic cancer: a multicenter review of 895 patients. BMC Gastroenterol 17:66CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Marechal R, Demols A, Gay F et al (2008) Tolerance and efficacy of gemcitabine and gemcitabine-based regimens in elderly patients with advanced pancreatic cancer. Pancreas 36(3):e16–e21CrossRefPubMed Marechal R, Demols A, Gay F et al (2008) Tolerance and efficacy of gemcitabine and gemcitabine-based regimens in elderly patients with advanced pancreatic cancer. Pancreas 36(3):e16–e21CrossRefPubMed
12.
Zurück zum Zitat Jin J, Teng C, Li T et al (2018) Combination therapy versus gemcitabine monotherapy in the treatment of elderly pancreatic cancer: a meta-analysis of randomized controlled trials. Drug Desi Dev Ther 12:475–480CrossRef Jin J, Teng C, Li T et al (2018) Combination therapy versus gemcitabine monotherapy in the treatment of elderly pancreatic cancer: a meta-analysis of randomized controlled trials. Drug Desi Dev Ther 12:475–480CrossRef
13.
Zurück zum Zitat Goldstein D, EI-Hassan R, Heinemann V et al (2015) Nab-paclitaxel plus gemcitabine for metastatic pancreatic cancer: long-term survival from a phase III trial. J Natl Cancer Inst 107(2):dju413CrossRefPubMed Goldstein D, EI-Hassan R, Heinemann V et al (2015) Nab-paclitaxel plus gemcitabine for metastatic pancreatic cancer: long-term survival from a phase III trial. J Natl Cancer Inst 107(2):dju413CrossRefPubMed
14.
Zurück zum Zitat Gwenalyn G, Odaimi M (2017) Systemic combination chemotherapy in elderly pancreatic cancer: a review. J Gastrointest Canc 48:121–128CrossRef Gwenalyn G, Odaimi M (2017) Systemic combination chemotherapy in elderly pancreatic cancer: a review. J Gastrointest Canc 48:121–128CrossRef
15.
Zurück zum Zitat Scheithauer W, Ramanathan RK, Moore M et al (2016) Dose modification- ton and efficacy of nab-paclitaxel plus gemcitabine vs. gemcitabine for patients with metastatic pancreatic cancer: phase III MPACT trial. J Gastrointest Oncol 7:469–478CrossRefPubMedPubMedCentral Scheithauer W, Ramanathan RK, Moore M et al (2016) Dose modification- ton and efficacy of nab-paclitaxel plus gemcitabine vs. gemcitabine for patients with metastatic pancreatic cancer: phase III MPACT trial. J Gastrointest Oncol 7:469–478CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Bladucci L, Extermann M (2000) Management of cancer in the older person: a practical approach. Oncologist 5(3):224–237CrossRef Bladucci L, Extermann M (2000) Management of cancer in the older person: a practical approach. Oncologist 5(3):224–237CrossRef
17.
Zurück zum Zitat Higuera O, Ghanem M, Nasimi R et al (2016) Management of pancreatic cancer in elderly. World J Gastroenterol 22(2):264–275CrossRef Higuera O, Ghanem M, Nasimi R et al (2016) Management of pancreatic cancer in elderly. World J Gastroenterol 22(2):264–275CrossRef
18.
Zurück zum Zitat Ahn DH, Krishna K, Blazer M et al (2017) A modified regimen of bi-weekly gemcitabine and nab-paclitaxel in patients with metastatic pancreatic cancer is both tolerable and effective: a retrospective analysis. Ther Adv Med Oncol 9(2):75–82CrossRefPubMed Ahn DH, Krishna K, Blazer M et al (2017) A modified regimen of bi-weekly gemcitabine and nab-paclitaxel in patients with metastatic pancreatic cancer is both tolerable and effective: a retrospective analysis. Ther Adv Med Oncol 9(2):75–82CrossRefPubMed
19.
Zurück zum Zitat Osman MAM, McDermott R, Fennelly D (2016) A modified regimen of nab-paclitaxel and gemcitabine in advanced pancreatic cancer. Ann Oncol 27(suppl 6):666P Osman MAM, McDermott R, Fennelly D (2016) A modified regimen of nab-paclitaxel and gemcitabine in advanced pancreatic cancer. Ann Oncol 27(suppl 6):666P
20.
Zurück zum Zitat Kou T, Kanai M, Yamamoto M et al (2016) Prognostic model for survival based on readily available pretreatment factors in patients with advanced pancreatic cancer receiving palliative chemotherapy. Int J Clin Oncol. 21:118–125CrossRefPubMed Kou T, Kanai M, Yamamoto M et al (2016) Prognostic model for survival based on readily available pretreatment factors in patients with advanced pancreatic cancer receiving palliative chemotherapy. Int J Clin Oncol. 21:118–125CrossRefPubMed
21.
Zurück zum Zitat Ueno H, Okada S, Okusaka T et al (2000) Prognostic factors in patients with metastatic pancreatic adenocarcinoma receiving systemic chemotherapy. Oncology 59(4):296–301CrossRefPubMed Ueno H, Okada S, Okusaka T et al (2000) Prognostic factors in patients with metastatic pancreatic adenocarcinoma receiving systemic chemotherapy. Oncology 59(4):296–301CrossRefPubMed
22.
Zurück zum Zitat Morizane C, Okusaka T, Morita S et al (2011) Construction and validation of a prognostic index for patients with metastatic pancreatic adenocarcinoma. Pancreas 40(3):415–421CrossRefPubMed Morizane C, Okusaka T, Morita S et al (2011) Construction and validation of a prognostic index for patients with metastatic pancreatic adenocarcinoma. Pancreas 40(3):415–421CrossRefPubMed
23.
Zurück zum Zitat Bauer TM, El-Rayes BF, Li X et al (2013) Carbohydrate antigen 19–9 is a prognostic and predictive biomarker in patients with advanced pancreatic cancer who receive gemcitabine-containing chemotherapy: a pooled analysis of 6 prospective trials. Cancer 119(2):285–292CrossRefPubMed Bauer TM, El-Rayes BF, Li X et al (2013) Carbohydrate antigen 19–9 is a prognostic and predictive biomarker in patients with advanced pancreatic cancer who receive gemcitabine-containing chemotherapy: a pooled analysis of 6 prospective trials. Cancer 119(2):285–292CrossRefPubMed
24.
Zurück zum Zitat Xue P, Kanai M, Mori Y et al (2014) Neutrophil-to-lymphocyte ratio for predicting palliative chemotherapy outcomes in advanced pancreatic cancer patients. Cancer Med 3(2):406–415CrossRefPubMedPubMedCentral Xue P, Kanai M, Mori Y et al (2014) Neutrophil-to-lymphocyte ratio for predicting palliative chemotherapy outcomes in advanced pancreatic cancer patients. Cancer Med 3(2):406–415CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Hamada T, Nakai Y, Yasunaga H et al (2014) Prognostic nomogram for nonresectable pancreatic cancer treated with gemcitabine-based chemotherapy. Br J Cancer 110(8):1943–1949CrossRefPubMedPubMedCentral Hamada T, Nakai Y, Yasunaga H et al (2014) Prognostic nomogram for nonresectable pancreatic cancer treated with gemcitabine-based chemotherapy. Br J Cancer 110(8):1943–1949CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat De Vita Ferdinando, Ventriglia Jole, Febbraro Antonino et al (2016) NAB-paclitaxel and gemcitabine in metastatic pancreatic ductal adenocarcinoma (PDAC): from clinical trials to clinical practice. BMC Cancer 16:709CrossRefPubMedPubMedCentral De Vita Ferdinando, Ventriglia Jole, Febbraro Antonino et al (2016) NAB-paclitaxel and gemcitabine in metastatic pancreatic ductal adenocarcinoma (PDAC): from clinical trials to clinical practice. BMC Cancer 16:709CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Josep T, Gabriela E, Jeffrey R et al (2015) Prognostic factors of survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic cancer. Oncologist 20:143–150CrossRef Josep T, Gabriela E, Jeffrey R et al (2015) Prognostic factors of survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic cancer. Oncologist 20:143–150CrossRef
28.
Zurück zum Zitat Lau MK, Davila JA, Shaib YH (2010) Incidence and survival of pancreatic head and body and tail cancers: a population-based study in the United States. Pancreas 39:458–462CrossRefPubMed Lau MK, Davila JA, Shaib YH (2010) Incidence and survival of pancreatic head and body and tail cancers: a population-based study in the United States. Pancreas 39:458–462CrossRefPubMed
29.
Zurück zum Zitat van Erning Felice N, Mackay Tara M, van der Geest Lydia GM et al (2018) Association of the location of pancreatic ductal adenocarcinoma (head, body, tail) with tumor stage, treatment, and survival: a population-based analysis. Acta Oncol 57(12):1655–1662CrossRefPubMed van Erning Felice N, Mackay Tara M, van der Geest Lydia GM et al (2018) Association of the location of pancreatic ductal adenocarcinoma (head, body, tail) with tumor stage, treatment, and survival: a population-based analysis. Acta Oncol 57(12):1655–1662CrossRefPubMed
30.
Zurück zum Zitat Humphris JL, Chang DK, Johns AL et al (2012) The prognostic and predictive value of serum CA19.9 in pancreatic cancer. Ann Oncol 23(7):1713–1722CrossRefPubMedPubMedCentral Humphris JL, Chang DK, Johns AL et al (2012) The prognostic and predictive value of serum CA19.9 in pancreatic cancer. Ann Oncol 23(7):1713–1722CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Meng Q, Shi S, Liang D et al (2017) Diagnostic and prognostic value of carcinoembryonic antigen in pancreatic cancer: a systematic review and meta-analysis. Onco Targetas Ther 10:4591–4598CrossRef Meng Q, Shi S, Liang D et al (2017) Diagnostic and prognostic value of carcinoembryonic antigen in pancreatic cancer: a systematic review and meta-analysis. Onco Targetas Ther 10:4591–4598CrossRef
33.
Zurück zum Zitat Betge J, Chi-Kern J, Schulte N et al (2018) A multicenter phase 4 geriatric assessment directed trial to evaluate gemcitabine +/- nab-paclitaxel in elderly pancreatic cancer patients. BMC Cancer 18(1):747CrossRefPubMedPubMedCentral Betge J, Chi-Kern J, Schulte N et al (2018) A multicenter phase 4 geriatric assessment directed trial to evaluate gemcitabine +/- nab-paclitaxel in elderly pancreatic cancer patients. BMC Cancer 18(1):747CrossRefPubMedPubMedCentral
Metadaten
Titel
The efficacy and safety of nab paclitaxel plus gemcitabine in elderly patients over 75 years with unresectable pancreatic cancer compared with younger patients
verfasst von
Utako Ishimoto
Akiyoshi Kinoshita
Yuki Hirose
Keiko Shibata
Ayako Ishii
Ryo Shoji
Takeharu Yokota
Akira Iwaku
Yusuke Mizuno
Kazuhiko Koike
Masayuki Saruta
Publikationsdatum
22.06.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Cancer Chemotherapy and Pharmacology / Ausgabe 3/2019
Print ISSN: 0344-5704
Elektronische ISSN: 1432-0843
DOI
https://doi.org/10.1007/s00280-019-03895-2

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