Role of neoadjuvant therapy in the multimodality treatment of older patients with pancreatic cancer

Amanda Cooper, Holly M. Holmes, Jude K.A. Des Bordes, David Fogelman, Nathan H. Parker, Jeffrey E. Lee, Thomas A. Aloia, Jean Nicolas Vauthey, Jason B. Fleming, Matthew H.G. Katz

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Abstract

Background A well-defined treatment strategy for elderly patients with resectable pancreatic cancer is lacking. Multiple reports have described highly selected older cancer patients who have successfully undergone pancreatectomy. However, multimodality therapy is essential for long-term survival, and elderly patients are at high risk for not receiving adjuvant therapy postoperatively. We sought to describe the treatment patterns and outcomes of a series of elderly patients with pancreatic cancer who were treated with a multimodality strategy that liberally used neoadjuvant therapy. Study Design We retrospectively reviewed treatment plans, short-term outcomes, and overall survival of all patients 70 years old and older, presenting to our institution over a 9-year period, who were treated for potentially resectable or borderline resectable pancreatic cancer. Results There were 179 (76%) of 236 patients treated with curative intent. Of these patients, 153 (85%) initiated neoadjuvant therapy: 74 (48%) subsequently underwent pancreatectomy and 79 did not due to disease progression (n = 46), insufficient performance status (n = 23), or other reasons (n = 10). Eleven (42%) of 26 patients who underwent surgery first received postoperative therapy. Among patients treated with curative intent, the median overall survival of all patients initiating neoadjuvant therapy (16.6 months [range 2.1 to 142.7 months]) was similar to that of patients undergoing resection primarily (15.1 months [range 5.4 to 100.8 months]), p = 0.53. After pancreatectomy, patients had a 2% in-hospital mortality rate and 91% were discharged home. Conclusions Eighty-five percent of all patients 70 years old and older, who underwent pancreatectomy for potentially resectable or borderline resectable pancreatic cancer, received multimodality therapy. More than 90% were discharged home. These data demonstrate a potential role for neoadjuvant therapy in selecting elderly patients for surgery, and support further studies to refine individualized treatment protocols for this high-risk population.

Original languageEnglish (US)
Pages (from-to)111-120
Number of pages10
JournalJournal of the American College of Surgeons
Volume219
Issue number1
DOIs
StatePublished - Jan 1 2014

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Neoadjuvant Therapy
Pancreatic Neoplasms
Pancreatectomy
Therapeutics
Survival
Clinical Protocols
Hospital Mortality
Disease Progression

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Cooper, Amanda ; Holmes, Holly M. ; Des Bordes, Jude K.A. ; Fogelman, David ; Parker, Nathan H. ; Lee, Jeffrey E. ; Aloia, Thomas A. ; Vauthey, Jean Nicolas ; Fleming, Jason B. ; Katz, Matthew H.G. / Role of neoadjuvant therapy in the multimodality treatment of older patients with pancreatic cancer. In: Journal of the American College of Surgeons. 2014 ; Vol. 219, No. 1. pp. 111-120.
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title = "Role of neoadjuvant therapy in the multimodality treatment of older patients with pancreatic cancer",
abstract = "Background A well-defined treatment strategy for elderly patients with resectable pancreatic cancer is lacking. Multiple reports have described highly selected older cancer patients who have successfully undergone pancreatectomy. However, multimodality therapy is essential for long-term survival, and elderly patients are at high risk for not receiving adjuvant therapy postoperatively. We sought to describe the treatment patterns and outcomes of a series of elderly patients with pancreatic cancer who were treated with a multimodality strategy that liberally used neoadjuvant therapy. Study Design We retrospectively reviewed treatment plans, short-term outcomes, and overall survival of all patients 70 years old and older, presenting to our institution over a 9-year period, who were treated for potentially resectable or borderline resectable pancreatic cancer. Results There were 179 (76{\%}) of 236 patients treated with curative intent. Of these patients, 153 (85{\%}) initiated neoadjuvant therapy: 74 (48{\%}) subsequently underwent pancreatectomy and 79 did not due to disease progression (n = 46), insufficient performance status (n = 23), or other reasons (n = 10). Eleven (42{\%}) of 26 patients who underwent surgery first received postoperative therapy. Among patients treated with curative intent, the median overall survival of all patients initiating neoadjuvant therapy (16.6 months [range 2.1 to 142.7 months]) was similar to that of patients undergoing resection primarily (15.1 months [range 5.4 to 100.8 months]), p = 0.53. After pancreatectomy, patients had a 2{\%} in-hospital mortality rate and 91{\%} were discharged home. Conclusions Eighty-five percent of all patients 70 years old and older, who underwent pancreatectomy for potentially resectable or borderline resectable pancreatic cancer, received multimodality therapy. More than 90{\%} were discharged home. These data demonstrate a potential role for neoadjuvant therapy in selecting elderly patients for surgery, and support further studies to refine individualized treatment protocols for this high-risk population.",
author = "Amanda Cooper and Holmes, {Holly M.} and {Des Bordes}, {Jude K.A.} and David Fogelman and Parker, {Nathan H.} and Lee, {Jeffrey E.} and Aloia, {Thomas A.} and Vauthey, {Jean Nicolas} and Fleming, {Jason B.} and Katz, {Matthew H.G.}",
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Cooper, A, Holmes, HM, Des Bordes, JKA, Fogelman, D, Parker, NH, Lee, JE, Aloia, TA, Vauthey, JN, Fleming, JB & Katz, MHG 2014, 'Role of neoadjuvant therapy in the multimodality treatment of older patients with pancreatic cancer', Journal of the American College of Surgeons, vol. 219, no. 1, pp. 111-120. https://doi.org/10.1016/j.jamcollsurg.2014.02.023

Role of neoadjuvant therapy in the multimodality treatment of older patients with pancreatic cancer. / Cooper, Amanda; Holmes, Holly M.; Des Bordes, Jude K.A.; Fogelman, David; Parker, Nathan H.; Lee, Jeffrey E.; Aloia, Thomas A.; Vauthey, Jean Nicolas; Fleming, Jason B.; Katz, Matthew H.G.

In: Journal of the American College of Surgeons, Vol. 219, No. 1, 01.01.2014, p. 111-120.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Role of neoadjuvant therapy in the multimodality treatment of older patients with pancreatic cancer

AU - Cooper, Amanda

AU - Holmes, Holly M.

AU - Des Bordes, Jude K.A.

AU - Fogelman, David

AU - Parker, Nathan H.

AU - Lee, Jeffrey E.

AU - Aloia, Thomas A.

AU - Vauthey, Jean Nicolas

AU - Fleming, Jason B.

AU - Katz, Matthew H.G.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background A well-defined treatment strategy for elderly patients with resectable pancreatic cancer is lacking. Multiple reports have described highly selected older cancer patients who have successfully undergone pancreatectomy. However, multimodality therapy is essential for long-term survival, and elderly patients are at high risk for not receiving adjuvant therapy postoperatively. We sought to describe the treatment patterns and outcomes of a series of elderly patients with pancreatic cancer who were treated with a multimodality strategy that liberally used neoadjuvant therapy. Study Design We retrospectively reviewed treatment plans, short-term outcomes, and overall survival of all patients 70 years old and older, presenting to our institution over a 9-year period, who were treated for potentially resectable or borderline resectable pancreatic cancer. Results There were 179 (76%) of 236 patients treated with curative intent. Of these patients, 153 (85%) initiated neoadjuvant therapy: 74 (48%) subsequently underwent pancreatectomy and 79 did not due to disease progression (n = 46), insufficient performance status (n = 23), or other reasons (n = 10). Eleven (42%) of 26 patients who underwent surgery first received postoperative therapy. Among patients treated with curative intent, the median overall survival of all patients initiating neoadjuvant therapy (16.6 months [range 2.1 to 142.7 months]) was similar to that of patients undergoing resection primarily (15.1 months [range 5.4 to 100.8 months]), p = 0.53. After pancreatectomy, patients had a 2% in-hospital mortality rate and 91% were discharged home. Conclusions Eighty-five percent of all patients 70 years old and older, who underwent pancreatectomy for potentially resectable or borderline resectable pancreatic cancer, received multimodality therapy. More than 90% were discharged home. These data demonstrate a potential role for neoadjuvant therapy in selecting elderly patients for surgery, and support further studies to refine individualized treatment protocols for this high-risk population.

AB - Background A well-defined treatment strategy for elderly patients with resectable pancreatic cancer is lacking. Multiple reports have described highly selected older cancer patients who have successfully undergone pancreatectomy. However, multimodality therapy is essential for long-term survival, and elderly patients are at high risk for not receiving adjuvant therapy postoperatively. We sought to describe the treatment patterns and outcomes of a series of elderly patients with pancreatic cancer who were treated with a multimodality strategy that liberally used neoadjuvant therapy. Study Design We retrospectively reviewed treatment plans, short-term outcomes, and overall survival of all patients 70 years old and older, presenting to our institution over a 9-year period, who were treated for potentially resectable or borderline resectable pancreatic cancer. Results There were 179 (76%) of 236 patients treated with curative intent. Of these patients, 153 (85%) initiated neoadjuvant therapy: 74 (48%) subsequently underwent pancreatectomy and 79 did not due to disease progression (n = 46), insufficient performance status (n = 23), or other reasons (n = 10). Eleven (42%) of 26 patients who underwent surgery first received postoperative therapy. Among patients treated with curative intent, the median overall survival of all patients initiating neoadjuvant therapy (16.6 months [range 2.1 to 142.7 months]) was similar to that of patients undergoing resection primarily (15.1 months [range 5.4 to 100.8 months]), p = 0.53. After pancreatectomy, patients had a 2% in-hospital mortality rate and 91% were discharged home. Conclusions Eighty-five percent of all patients 70 years old and older, who underwent pancreatectomy for potentially resectable or borderline resectable pancreatic cancer, received multimodality therapy. More than 90% were discharged home. These data demonstrate a potential role for neoadjuvant therapy in selecting elderly patients for surgery, and support further studies to refine individualized treatment protocols for this high-risk population.

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