title: Systemic Combination Chemotherapy in Elderly Pancreatic Cancer: a Review.
abstract: OBJECTIVE
  In recent years, significant progress in survival has been achieved using systemic combination chemotherapy in patients with pancreatic cancer. However, the elderly are largely underrepresented in clinical trials, and gains made from these may not necessarily apply to this important subgroup of patients. We review the currently available data regarding contemporary combination chemotherapy regimens, including FOLFIRINOX, gemcitabine plus nab-paclitaxel, nanoliposomal irinotecan plus 5-fluorouracil and leucovorin, and gemcitabine plus capecitabine, in elderly pancreatic cancer patients.
  
  
  METHODS
  We performed a search of Pubmed using the terms "pancreatic cancer", "elderly", "FOLFIRINOX", "gemcitabine", "nab-paclitaxel", "capecitabine", and "nanoliposomal irinotecan" and included articles investigating the use of combination chemotherapy in the elderly with pancreatic adenocarcinoma. Relevant abstracts from American Society of Clinical Oncology and European Society of Medical Oncology meetings were included.
  
  
  RESULTS
  Current clinical evidence and experience suggests that relatively fit elderly pancreatic cancer patients may derive significant benefit from contemporary combination chemotherapy regimens. Strategies to improve tolerability without decreasing efficacy include dose reduction, schedule modification, and growth factor support. Phase III clinical trials are ongoing to determine the optimal use of combination chemotherapy regimens in elderly patients with pancreatic cancer.
  
  
  CONCLUSIONS
  Identifying elderly patients who will benefit from combination chemotherapy for pancreatic cancer remains a significant clinical challenge. An assessment of medical comorbidities and functional status plays a key role in determining fitness for intensive chemotherapeutic regimens in this important subset of patients.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA. ggarcia8@northwell.edu.
authors.forename: Gwenalyn
authors.identifier: http://orcid.org/0000-0001-8342-5052
authors.initials: G
authors.lastname: Garcia
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA.
authors.forename: Marcel
authors.initials: M
authors.lastname: Odaimi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology* / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods / Q000639:trends; D002986:Clinical Trials as Topic; D006801:Humans; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Capecitabine; Elderly; FOLFIRINOX; Gemcitabine; Nab-paclitaxel; Nanoliposomal irinotecan; Pancreatic cancer