Nab-paclitaxel plus gemcitabine as first-line palliative chemotherapy in a patient with metastatic pancreatic cancer with Eastern Cooperative Oncology Group performance status of 2

Background: Advanced age is the most important risk factor for pancreatic cancer and about half of patients are diagnosed with metastatic disease. In the first-line setting, multidrug chemotherapy regimens were shown to be more effective than gemcitabine alone. However, the older population was under-represented in randomized clinical trials. We aimed to describe the clinical profile of older patients with metastatic pancreatic cancer and their survival outcomes. Materials and methods: This was a retrospective, unicentric study that included patients diagnosed with metastatic pancreatic cancer (non-neuroendocrine), aged 65 years and over. Results: The study population comprised 196 patients. The median age was 73 years; 67% of these patients presented Eastern Cooperative Oncology Group performance status (ECOG) ⩽ 1 and the median Charlson Comorbidity score was 10. Chemotherapy was given to 89% of the patients. The most frequently used chemotherapy regimens were gemcitabine (44%), 5-fluorouracil and oxaliplatin [FOLFOX; 26%], and 5-fluorouracil, oxaliplatin and irinotecan (FOLFIRINOX; 20%). Patients treated with FOLFIRINOX were younger and they presented better performance status. After a median follow up of 19.8 months, the median overall survival (OS) was of 7.2 months and the median time to first-line-treatment failure was 4.6 months. Among patients treated with chemotherapy, the median OS was highest for those treated with FOLFIRINOX (13.8 months), as compared with FOLFOX (7.0 months) or gemcitabine (6.7 months); p = 0.004. Nonetheless, treatment with FOLFIRINOX was associated with increased risk of severe toxicity ( p = 0.008). Conclusion: Older patients with metastatic pancreatic cancer benefit from palliative chemotherapy, and FOLFIRINOX is a therapeutic option in rigorously selected older patients.

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Combination Chemotherapy in Patients With Advanced Pancreatic Cancer With an Eastern Cooperative Oncology Group Performance Status of 2: Lights and Shadows of a Frail Route

Journal of Clinical Oncology ◽

10.1200/jco.19.00127 ◽

2019 ◽

Vol 37 (22) ◽

pp. 1978-1979 ◽

Cited By ~ 1

Author(s):

Irene Pecora ◽

Lorenzo Fornaro ◽

Enrico Vasile ◽

Silvia Catanese ◽

Francesca Salani ◽

...

Keyword(s):

Pancreatic Cancer ◽

Combination Chemotherapy ◽

Group Performance ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Advanced Pancreatic Cancer ◽

Oncology Group

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The combination of serum NLR and D-dimer levels at diagnosis predicts overall survival in metastatic pancreatic cancer

10.21203/rs.3.rs-21740/v1 ◽

2020 ◽

Author(s):

Pei Mei ◽

Qiong Gong ◽

Yu-Ping Rong ◽

Jian Chang ◽

Qi Fang ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Group Performance ◽

Univariate Analysis ◽

Eastern Cooperative Oncology Group ◽

Metastatic Pancreatic Cancer ◽

Inflammatory Factors ◽

Lymphocyte Ratio ◽

Prognostic Predictors ◽

D Dimer

Abstract Background Many studies have confirmed that the systemic inflammatory response and hypercoagulable state of the patient are related to the occurrence and development of various tumors, including pancreatic cancer. The aim of this research was to combine blood inflammatory factors and D-dimer into a new prognostic scoring system.Methods We conducted a retrospective cohort study of 73 patients with metastatic pancreatic cancer between January 2015 and December 2018 at our institution. To identify the prognostic predictors, circulating inflammatory cells and D-dimer were analyzed.Results Univariate analysis showed that the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), CA19-9, Eastern Cooperative Oncology Group performance status (ECOG PS) score and D-dimer levels were significantly associated with overall survival in patients with metastatic pancreatic cancer. Multivariate analysis suggested that only the NLR (p<0.026) and D-dimer level (p<0.012) were independent prognostic predictors. Then, we combined the NLR and D-dimer level to divide the cohort into three “NLRD” groups: “NLRD0”=NLR≤3.38 and D-dimer≤1.47, “NLRD1”=either NLR>3.38 or D-dimer>1.47, “NLRD2”=NLR>3.38 and D-dimer>1.47. Finally, we found that the NLRD2 group had the worst survival, with a median overall survival (OS) of 2 months (95%CI=1.450-2.550), while the NLRD0 group had the best outcome, with a median OS of 7 months (95%CI=5.897-8.121).Conclusions The scoring system combining the blood NLR with D-dimer levels provides important prognostic information for risk stratification in patients with metastatic pancreatic cancer and may help us identify patients who have a poor prognosis so that clinicians can develop personalized treatment strategies for these patients.

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Comprehensive Geriatric Assessment Adds Information to Eastern Cooperative Oncology Group Performance Status in Elderly Cancer Patients: An Italian Group for Geriatric Oncology Study

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.2.494 ◽

2002 ◽

Vol 20 (2) ◽

pp. 494-502 ◽

Cited By ~ 291

Author(s):

Lazzaro Repetto ◽

Lucia Fratino ◽

Riccardo A. Audisio ◽

Antonella Venturino ◽

Walter Gianni ◽

...

Keyword(s):

Cancer Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Daily Living ◽

Group Performance ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Geriatric Oncology ◽

Oncology Group ◽

Elderly Cancer Patients

PURPOSE: To appraise the performance of Comprehensive Geriatric Assessment (CGA) in elderly cancer patients (≥ 65 years) and to evaluate whether it could add further information with respect to the Eastern Cooperative Oncology Group performance status (PS). PATIENTS AND METHODS: We studied 363 elderly cancer patients (195 males, 168 females; median age, 72 years) with solid (n = 271) or hematologic (n = 92) tumors. In addition to PS, their physical function was assessed by means of the activity of daily living (ADL) and instrumental activities of daily living (IADL) scales. Comorbidities were categorized according to Satariano’s index. The association between PS, comorbidity, and the items of the CGA was assessed by means of logistic regression analysis. RESULTS: These 363 elderly cancer patients had a good functional and mental status: 74% had a good PS (ie, lower than 2), 86% were ADL-independent, and 52% were IADL-independent. Forty-one percent of patients had one or more comorbid conditions. Of the patients with a good PS, 13.0% had two or more comorbidities; 9.3% and 37.7% had ADL or IADL limitations, respectively. By multivariate analysis, elderly cancer patients who were ADL-dependent or IADL-dependent had a nearly two-fold higher probability of having an elevated Satariano’s index than independent patients. A strong association emerged between PS and CGA, with a nearly five-fold increased probability of having a poor PS (ie, ≥ 2) recorded in patients dependent for ADL or IADL. CONCLUSION: The CGA adds substantial information on the functional assessment of elderly cancer patients, including patients with a good PS. The role of PS as unique marker of functional status needs to be reappraised among elderly cancer patients.

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Pancreatic cancer outcomes in Nova Scotia: Searching for small windows of opportunity.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e16219 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e16219-e16219

Author(s):

Peiran Sun ◽

Ravi Ramjeesingh

Keyword(s):

Older Adults ◽

Pancreatic Cancer ◽

Multivariate Analysis ◽

Nova Scotia ◽

Group Performance ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Healthcare Delivery ◽

Wait Times ◽

Significant Difference

e16219 Background: While pancreatic cancer (PC) globally has poor outcomes, there are still regional variation in PC outcomes in Canada. Nova Scotia (NS) has been documented to have some of the worst outcomes in PC but the details and barriers to the care of PC in NS have never been analyzed. Methods: A retrospective chart review was performed on PC patients (pts) diagnosed in NS from 2013 to 2017 for patient characteristics, referral pattern, treatments and wait times. Cox proportional hazards methods were used to analyze overall survival (OS) with Age, Stage, Eastern Cooperative Oncology Group Performance Status (PS), Charleston Comorbidity Index (CCI), receiving ERCP and receiving chemotherapy as covariates in the multivariate analysis. Results: 667 consecutive pts were identified, which included 357 males and 310 females with a median age of 71 at diagnosis. 42 (6.25%) lived beyond 2 years, while 163 (24.4%) survived for under 30 days and 260 (39%) survived for under 60 days. Patients with a limited survival (under 30 days) when compared to pts who survived > 60 days are older (mean 75 vs 71, P < 0.05), had a higher proportion of ECOG > 2 (81.6% vs 20.3%, P < 0.01), and a higher proportion of stage 4 disease (73.9% vs 41.2%, P < 0.01). There was no significant difference in any measure of wait times. Pts with limited survival were less likely to be seen by Medical Oncology (MO) (20.9% vs 70.9%, P < 0.001), and less likely to receive chemotherapy (1.2% vs 45%, P < 0.001) or ERCP (27% vs 53.8%, P < 0.01). Multivariate analysis showed that receiving ERCP (P = 0.027) and chemotherapy(P < 0.001) are independent predictors of survival, even when accounting for PS, CCI, stage, and age. Conclusions: Analysis of PC outcomes in NS demonstrates a large proportion of pts dying within 30 days of diagnosis. Those pts are older and present with higher stage and worse PS but did not have any significant difference in diagnostic and referral wait times. Those pts receive fewer referrals to Oncology services, fewer potentially life prolonging treatments and we uniquely discovered ERCP as an independent predictor of survival in our population. While further work is needed, this study characterized some of the unique challenges of PC care in NS as a province with a higher proportional of older adults and highlights potential opportunities to improve early healthcare delivery in older adults with limited windows for care.

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Attenuated regimen of biweekly gemcitabine/nab-paclitaxel in patients aged 65 years or older with advanced pancreatic cancer

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820974912 ◽

2020 ◽

Vol 13 ◽

pp. 175628482097491

Author(s):

Hasan Rehman ◽

Jeffrey Chi ◽

Nausheen Hakim ◽

Shreya Prasad Goyal ◽

Coral Olazagasti ◽

...

Keyword(s):

Pancreatic Cancer ◽

Group Performance ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Advanced Pancreatic Cancer ◽

Progression Free Survival ◽

Poor Performance ◽

Poor Performance Status ◽

Weekly Schedule ◽

Dose Reductions

Background: Treatment with gemcitabine/nab-paclitaxel confers a survival benefit over gemcitabine monotherapy in patients with advanced pancreatic cancer (APC). However, such treatment can be associated with significant toxicities especially in older patients and carries practical disadvantages related to a weekly schedule along with financial cost. We retrospectively analyzed patients >65 years of age with APC who received a modified biweekly regimen of gemcitabine/nab-paclitaxel to evaluate efficacy and toxicity. Methods: Patients aged >65 years with chemo-naïve APC with Eastern Cooperative Oncology Group performance status ⩽2 were studied. Patients were treated with a modified regimen of gemcitabine 1000 mg/m2 and nab-paclitaxel 125 mg/m2 every 2 weeks on days 1 and 15 of a 28-day cycle. Patients were evaluated for progression-free survival (PFS) and overall survival (OS) with analyses performed using the Kaplan–Meier method. Adverse events were recorded on the day of chemotherapy. Cancer antigen 19.9 was measured in every cycle and restaging scans were performed every two cycles. Results: A total of 73 patients (median age: 73 years; range: 66–93) were treated with biweekly gemcitabine/nab-paclitaxel as first-line treatment. The median OS and PFS were 9.1 months and 4.8 months, respectively. Around 66% of patients received growth-factor support based on American Society of Clinical Oncology guidelines and no patient developed neutropenic fever. The incidences of grade ⩾3 toxicity for neutropenia, anemia, thrombocytopenia, and neurotoxicity were 2%, 7%, 3%, and 5%, respectively. Dose reductions of gemcitabine/nab-paclitaxel were required in 10% and 4% patients, respectively. Conclusion: In patients older than >65 years of age with APC, a modified regimen of biweekly gemcitabine/nab-paclitaxel was found to be effective when compared with the historical control from the MPACT study. This regimen allowed for fewer dose reductions, reduced healthcare costs from additional appointments, travel-related cost, as well as a favorable side-effect profile while maintaining efficacy. Though retrospective in nature, this study underlines the need for further investigation, particularly in elderly patients with poor performance status, such as those with pancreatic cancer, and in order to combine with a third agent, such as a targeted treatment or immunotherapy.

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Prognostic factors of ado-trastuzumab emtansine treatment in patients with metastatic HER-2 positive breast cancer

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155220924088 ◽

2020 ◽

pp. 107815522092408 ◽

Cited By ~ 1

Author(s):

Deniz Tataroglu Ozyukseler ◽

Mustafa Basak ◽

Seval Ay ◽

Aygül Koseoglu ◽

Serdar Arıcı ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Group Performance ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Progression Free Survival ◽

Trastuzumab Emtansine ◽

Oncology Group ◽

Cancer Antigen ◽

Free Survival

Background Ado-trastuzumab emtansine is an antibody-drug conjugate that combines the cytotoxic activity of emtansine with human epidermal growth factor receptor 2-targeted antitumor features of trastuzumab. Objective We conducted a study of metastatic breast cancer patients treated with trastuzumab emtansine. By evaluating progression-free survival, overall survival, and response rates, we aimed to find prognostic factors of trastuzumab emtansine treatment. Methods Our study is a single-center, retrospective, observational study. We have clinical data from 78 patients treated with trastuzumab emtansine for metastatic breast cancer, from May 2016 through May 2019, at Kartal Dr Lutfi Kirdar Education and Research Hospital, Medical Oncology Department. Our objective is to assess the survival and response rates in trastuzumab emtansine-treated individuals and the factors associated with survival. The factors we analyzed were cancer antigen 15-3 sensitivity, Eastern Cooperative Oncology Group-Performance Status, presence or absence of visceral metastases, presence or absence of cranial metastases, and treatment-associated thrombocytopenia. Results Among 78 patients, median progression-free survival was 7.8 months, and overall survival was 21.1 months. Twenty of the patients had an objective tumor response. The results showed that trastuzumab emtansine was tolerable with a manageable safety profile and consistent with the results of the previous literature. Mostly seen adverse events were anemia, thrombocytopenia, fatigue, and increased levels of alkaline phosphatase. Patients with Eastern Cooperative Oncology Group-Performance Status = 2 had worse progression-free survival and overall survival compared to ones with Eastern Cooperative Oncology Group-Performance Status < 2; progression-free survival and overall survival are worse in cancer antigen 15-3-sensitive breast cancer patients. According to our findings, treatment-associated thrombocytopenia was a significant prognostic factor for survival. Patients with thrombocytopenia had 12 months progression-free survival, whereas patients without thrombocytopenia had only 4.1 months progression-free survival. In like manner, overall survival was much better in the thrombocytopenia-experienced patients as 29.5 versus 11.8 months. Conclusions Trastuzumab emtansine prolongs progression-free survival and overall survival with a manageable safety profile. Thrombocytopenia, Eastern Cooperative Oncology Group-Performance Status, and cancer antigen 15-3 are correlated with progression-free survival and/or overall survival.

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