title: Adjuvant chemotherapy in elderly patients with pancreatic cancer.
abstract: BACKGROUND
  Adjuvant chemotherapy improves survival for patients with resected pancreatic cancer. Elderly patients are under-represented in Phase III clinical trials, and as a consequence the efficacy of adjuvant therapy in older patients with pancreatic cancer is not clear. We aimed to assess the use and efficacy of adjuvant chemotherapy in older patients with pancreatic cancer.
  
  
  METHODS
  We assessed a community cohort of 439 patients with a diagnosis of pancreatic ductal adenocarcinoma who underwent operative resection in centres associated with the Australian Pancreatic Cancer Genome Initiative.
  
  
  RESULTS
  The median age of the cohort was 67 years. Overall only 47% of all patients received adjuvant therapy. Patients who received adjuvant chemotherapy were predominantly younger, had later stage disease, more lymph node involvement and more evidence of perineural invasion than the group that did not receive adjuvant treatment. Overall, adjuvant chemotherapy was associated with prolonged survival (median 22.1 vs 15.8 months; P<0.0001). Older patients (aged ≥70) were less likely to receive adjuvant chemotherapy (51.5% vs 29.8%; P<0.0001). Older patients had a particularly poor outcome when adjuvant therapy was not delivered (median survival=13.1 months; HR 1.89, 95% CI: 1.27-2.78, P=0.002).
  
  
  CONCLUSIONS
  Patients aged ≥70 are less likely to receive adjuvant therapy although it is associated with improved outcome. Increased use of adjuvant therapy in older individuals is encouraged as they constitute a large proportion of patients with pancreatic cancer.
authors.affiliation: The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia.
authors.forename: A M
authors.initials: AM
authors.lastname: Nagrial
authors.affiliation: 1] The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia [2] Department of Surgery, Bankstown Hospital, Eldridge Road, Bankstown, Sydney NSW 2200, Australia [3] South Western Sydney Clinical School, Faculty of Medicine, University of NSW, Liverpool NSW 2170, Australia [4] Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow G61 1BD, Scotland, UK.
authors.forename: D K
authors.initials: DK
authors.lastname: Chang
authors.affiliation: The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia.
authors.forename: N Q
authors.initials: NQ
authors.lastname: Nguyen
authors.affiliation: The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia.
authors.forename: A L
authors.initials: AL
authors.lastname: Johns
authors.affiliation: 1] The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia [2] Macarthur Cancer Therapy Centre, Campbelltown, NSW 2560, Australia.
authors.forename: L A
authors.initials: LA
authors.lastname: Chantrill
authors.affiliation: The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia.
authors.forename: J L
authors.initials: JL
authors.lastname: Humphris
authors.affiliation: The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia.
authors.forename: V T
authors.initials: VT
authors.lastname: Chin
authors.affiliation: Department of Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia.
authors.forename: J S
authors.initials: JS
authors.lastname: Samra
authors.affiliation: 1] Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia [2] Sydney Medical School, University of Sydney, Sydney, NSW 2006; Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Gill
authors.affiliation: The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Pajic
authors.affiliation: The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Pinese
authors.affiliation: The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia.
authors.forename: E K
authors.initials: EK
authors.lastname: Colvin
authors.affiliation: 1] The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia [2] School of Environmental and Life Sciences, University of Newcastle, Ourimbah, NSW 2258, Australia.
authors.forename: C J
authors.initials: CJ
authors.lastname: Scarlett
authors.affiliation: 1] The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia [2] Department of Anatomical Pathology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW 2010, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Chou
authors.affiliation: 1] The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia [2] Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
authors.forename: J G
authors.initials: JG
authors.lastname: Kench
authors.affiliation: 1] The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia [2] St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: R L
authors.initials: RL
authors.lastname: Sutherland
authors.affiliation: 1] The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia [2] Department of Medical Oncology, Sydney Cancer Centre, Sydney, NSW 2050, Australia.
authors.forename: L G
authors.initials: LG
authors.lastname: Horvath
authors.affiliation: 1] The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia [2] Department of Surgery, Bankstown Hospital, Eldridge Road, Bankstown, Sydney NSW 2200, Australia [3] South Western Sydney Clinical School, Faculty of Medicine, University of NSW, Liverpool NSW 2170, Australia [4] Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow G61 1BD, Scotland, UK.
authors.forename: A V
authors.initials: AV
authors.lastname: Biankin
mesh_terms: D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000187:drug effects / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D011379:Prognosis
chemical_list: D000970:Antineoplastic Agents