A250 UNRESEQUABLE AND METASTATIC PANCREATIC ADENOCARCINOMA IN THE ELDERLY: A 10-YEAR SINGLE-CENTER EXPERIENCE

Pancreatic adenocarcinoma is the fourth leading cause of cancer deaths in Canada and mainly affects individuals older than 60 years of age. Because of its retroperitoneal location, pancreatic cancer follows a relatively silent clinical course and is more often diagnosed at an advanced stage. When faced with a diagnosis of unresectable pancreatic adenocarcinoma, patients may be offered palliative chemotherapy. Unfortunately, a paucity of data exists regarding the use of chemotherapeutic agents in the elderly population with pancreatic cancer. The objective of this study is to obtain adequate profiling of the elderly patients with pancreatic cancer to better assess factors influencing outcomes and decision-making. This is a retrospective observational study of all patients aged older than 75 years old with a diagnosis of unresectable or metastatic pancreatic cancer at the CHUS between June 2005 and June 2015. Data was retrieved using the local patient database program Ariane. During the study period, 225 patients were included according to the entry criteria. Median age at diagnosis was 82 years old with a slight female gender predominance (52% vs 48%). Location of the primary tumor was in the head of the pancreas in 46% of cases, and evenly distributed between the pancreatic body and tail. Diagnosis was made by the general practitioners or gastroenterologists in 73.4% of cases. High blood pressure, diabetes mellitus and coronary atherosclerosis were the most frequently encountered comorbidities. Other biochemistry parameters at diagnosis suggested a more fragile population; median albumin level of 32 g/L, median creatinine value of 155 µmol/L and minor anemia (median = 11.7 g/dL). Among all patients, only 10 opted for palliative chemotherapy. ECOG status was unfortunately far from uniformly documented, although among the 10 patients treated, all had either ECOG 0 or 1 scores. Nine received Gemcitabine as first line whereas one patient was treated with Folfirinox. Seven completed the treatment with the standard regimen dosage for each cycle. Patients received a median of 5 cycles and end of treatment was dictated by severe asthenia complicating treatment. Only 2 patients, non-responders, received second-line agents (5FU/LV) that were subsequently stopped, again for non-response. Results of this unicentric observational retrospective study suggest an overall diminished clinical performance status in elderly patients diagnosed with unresectable or metastatic pancreatic cancer when compared to their younger counterparts. Due to our small sample size, it remains difficult to draw conclusions on ideal patient selection criterion and palliative treatment for advanced pancreatic cancer in the elderly. The present study does, however, underline the dire need for further studies on the matter. None

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