Relative Dose Intensity and Outcomes in Elderly Patients With Resectable Pancreatic Cancer Receiving Neoadjuvant...

Neoadjuvant chemotherapy (NAC) with gemcitabine and S-1 (GS) is the standard regimen for resectable pancreatic cancer (PC) in Japan. However, its efficacy in elderly patients and those with impaired renal function remains unclear.

We retrospectively analyzed patients with resectable PC who received NAC GS. Patients were classified as elderly (≥ 75 years) or non-elderly (< 75 years). The primary endpoint was relative dose intensity (RDI) of NAC. Secondary endpoints included adverse events (AEs), perioperative outcomes, RDI of adjuvant chemotherapy (AC), recurrence-free survival (RFS), and overall survival (OS).

A total of 185 patients were included (non-elderly: 148, elderly: 37). Median creatinine clearance (CCr) was lower in elderly patients (64.2 vs. 84.5 mL/min, p < 0.001). Mean RDI of GS was significantly lower in elderly patients and those with CCr < 50 mL/min, particularly when both factors coexisted. Severe hematologic AEs were more frequent in these groups, though perioperative outcomes were similar. While initiation of AC was delayed and RDI of adjuvant S-1 was lower in elderly patients, RFS and OS did not significantly differ between groups.

NAC GS appears feasible in elderly patients with resectable PC, though caution is needed in those with impaired renal function.