Age-based outcomes and patterns of care of patients with metastatic pancreatic cancer: An updated comparative analysis from Fox Chase Cancer Center.

Abstract

668 Background: Prior analysis of patients with metastatic pancreatic cancer (mPC) treated at Fox Chase Cancer Center (FCCC) from 2000-2010 found that older adults >65 (OA) were less likely to receive treatment and more likely to get single-agent chemotherapy than younger adults <65 (YA). This analysis aimed to evaluate how treatment patterns, overall survival (OS), and predictors of OS by age have evolved following the adoption of multi-agent chemotherapy as standard of care over the last 10 years. Methods: Charts of 730 patients diagnosed with mPC between 2012-2022 and treated at FCCC were reviewed. Descriptive statistics were used to summarize patient demographics, disease characteristics, and treatment patterns. OS was estimated using Kaplan-Meier curves and compared between age groups using the log-rank test. Multivariable Cox proportional hazards models were used to adjust for potential confounders. Results: 304 YA (median age 59 years) and 426 OA (median age 73 years) were evaluated. There was no difference in likelihood of receiving chemotherapy (OA 78%, YA 81%, p=0.24) or number of treatment lines received (p=0.57) based on age. More YA received first-line FOLFIRINOX (YA 32%, OA 13.6%, p <0.001), whereas OA were more likely to receive gemcitabine/nab-paclitaxel (YA 33.6%, OA 40.5%) or fluorouracil-based doublet chemotherapy (YA 18.6%, OA 27.5%). There was no significant difference in patterns in second-line therapy based on age, though more OA received single agent second-line chemotherapy (YA 8%, OA 14%, p=0.187). There was no difference in OS based on age (YA: 10.7 mo vs OA: 8.7 mo, p = 0.056). There was no age-based difference in OS by lines of therapy (0, 1, 2+). OS was poor among patients who did not receive treatment and improved with each successive line of therapy regardless of age. Lung metastases were associated with improved OS (OA: p = 0.011; YA: p = 0.0056) while liver metastases were associated with inferior OS (OA: p = 0.0033; YA: p = 0.012). Conclusions: This study shows a narrowing in age-based treatment disparities over the last 10 years, with more OA receiving treatment. Although OA were less likely to receive first-line triplet chemotherapy, in line with standard practice, there were no other significant age-based differences in patterns of care. OS benefit correlated to lines of therapy patients received and was similar between groups. OA with mPC should not be precluded from treatment based on age alone; considering tolerability and quality of life remains critical as part of shared decision making in this population. Treatment patterns and median OS (months; [95% CI]) by age. Lines of Therapy Age < 65 Age > 65 P value N = 304 OS N=426 OS None 57 (18.8%) 4.57 [2.79-5.42] 95 (22.3%) 3.98 [2.92-6.11] 0.80 1 Line 124 (40.8%) 6.27 [5.29-9.43] 177 (41.5%) 5.65 [4.50-6.50] 0.17 >2 Lines 123 (40.4%) 16.1 [13.5-18.0] 154 (36.2%) 13.0 [12.0-16.0] 0.20