Chemotherapy and Supportive Care Practice Patterns Among Older Adults With Metastatic Pancreatic Cancer

Area of Science:

• Oncology
• Geriatric Medicine
• Health Services Research

Background:

• Metastatic pancreatic ductal adenocarcinoma (mPDAC) is a significant cause of cancer mortality.
• Established first-line chemotherapy options for mPDAC include FOLFIRINOX and gemcitabine with nab-paclitaxel (GnP).
• Treatment patterns in older adults with mPDAC are not well-understood.

Purpose of the Study:

• To analyze national trends in first-line chemotherapy selection for older adults with mPDAC.
• To identify factors influencing chemotherapy regimen choice in this population.
• To examine the receipt of second-line treatment among older adults with mPDAC.

Main Methods:

• Utilized the SEER-Medicare linked database (2010-2019) for a cohort aged 66+ diagnosed with mPDAC.
• Assessed temporal trends in first-line treatment selection, stratified by a frailty index.
• Employed multinomial logistic regression to determine associations between patient factors and treatment selection.

Main Results:

• Gemcitabine monotherapy decreased from 69.3% in 2010 to 16.6% in 2019, while GnP increased to 45.2% and FOLFIRINOX to 20.9%.
• FOLFIRINOX use in 2019 was 29.8% in robust, 19.8% in prefrail, and 6.8% in frail individuals.
• Age, sex, race/ethnicity, comorbidity, and frailty were associated with regimen selection; sequential therapy was common.

Conclusions:

• Chemotherapy utilization for older adults with mPDAC has evolved, with notable shifts in regimen preference.
• Treatment selection demonstrates significant variation across different levels of baseline frailty.
• Further research is needed to optimize chemotherapy selection for the geriatric population with mPDAC.