Gemcitabine as first-line chemotherapy in elderly patients with unresectable pancreatic carcinoma

• Published in: Journal of gastroenterology 2010-11, Vol.45 (11), p.1146-1154
• Main Authors: Yamagishi, Yoshiyuki, Higuchi, Hajime, Izumiya, Motoko, Sakai, Gen, Iizuka, Hideko, Nakamura, Shoko, Adachi, Masayuki, Hozawa, Sigenari, Takaishi, Hiromasa, Hibi, Toshifumi
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Age Factors; Aged; Aged patients; Aged, 80 and over; Antimetabolites, Antineoplastic - adverse effects; Antimetabolites, Antineoplastic - therapeutic use; Biliary Tract; Bone Marrow - drug effects; Bone Marrow - metabolism; CA19-9; Cancer; Cancer patients; Carcinoma; Care and treatment; Chemotherapy; Colorectal Surgery; Deoxycytidine - adverse effects; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; Dupan-2; elderly; Female; Gastroenterology; Gemcitabine; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm; Original Article—Liver; Pancreas; Pancreatic cancer; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - physiopathology; Prognosis; Proportional Hazards Models; Retrospective Studies; Surgical Oncology; Survival Rate; Treatment Outcome; Unresectable
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-010-0258-9

Background Gemcitabine (GEM) is the key drug for the chemotherapy of unresectable pancreatic cancer. However, the efficacy and safety of GEM has not been established in elderly patients. We retrospectively examined the prognosis of elderly pancreatic cancer patients treated with GEM. Methods Sixty-six patients with unresectable pancreatic cancer (pathologically identified) and no prior chemotherapy were divided into three groups. Group A: patients aged 70 years or more who received standard GEM (1000 mg/m²) on days 1, 8, and 15 and rest on day 21; Group B: patients less than 70 years old who received standard GEM therapy; and Group C: patients under best supportive care. Results Median survival times (MSTs) (days) were 311 in group A (p < 0.05 vs. group C), 292 in group B (p < 0.05 vs. group C), and 127 in group C. Among the patients who received GEM, 23% patients in group A and 16% patients in group B obtained partial responses. The response rates and MSTs were similar in groups A and B, as well as in more aged (≥75 years) patients. Bone marrow suppression was more frequently seen in elderly patients. Cox's hazard model in patients aged 70 years or more revealed that GEM therapy reduced the hazard ratio for death (hazard ratio: 0.683, p = 0.041). Conclusions Chemotherapy with GEM appears to be effective and safe in elderly patients as well as in younger patients. Patients with unresectable pancreatic carcinoma should receive GEM therapy even if they are aged 70 or more, even if they are aged 75 or more.