Role of chemotherapy in the very elderly patients with metastatic pancreatic cancer - A Veterans Affairs Cancer Registry analysis

Background: Metastatic pancreatic cancer is an incurable disease with dismal prognosis, ranging from 2 to 6. months. The role of chemotherapy for metastatic pancreatic cancer in very elderly patients (≥ 80 years) has not been well studied. Methods: We reviewed all cases of metastatic pancreatic cancer in patients aged ≥ 80 years in the Veterans Affairs Central Cancer Registry (VACCR) from 1995 to 2007. Four hundred and forty patients were identified. Type of therapy received, tumor grade, tobacco history, sex and race were noted. Overall survival was calculated by log rank and Kaplan-Meier analysis. Baseline co-morbid conditions were scored using the Charlson co-morbidity index score (CCIS), a validated measure of patient co-morbidity. Results: Among the 440 eligible patients in the analysis, the majority received no therapy (83%), while only 12% received chemotherapy alone. Multivariate analysis demonstrated that chemotherapy was associated with significant superior median overall survival (4.9. months, 95% CI 3.57-5.77) compared to no therapy (1.7. months, 95% CI 0.9-1.3) (HR = 0.41, p < 0.0001). One-year survival was higher in patients receiving chemotherapy compared to patients who received no therapy (13% vs. 3%). Current smoking was associated with decreased median overall survival compared to past or never smoking status (1.18 vs. 1.63 and 1.57. months respectively, p = 0.0087). Conclusion: Although the majority of elderly patients with metastatic pancreatic cancer do not receive any treatment, chemotherapy in this patient population was associated with improved median overall survival. Further randomized studies are warranted to confirm this observation.