Adjuvant chemotherapy in elderly patients with pancreatic cancer

Background: Adjuvant chemotherapy improves survival for patients with resected pancreatic cancer. Elderly patients are underrepresented 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). Conclusion: 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.