Metastatic pancreatic cancer in elderly patients.

Abstract

e16347 Background: Elderly patients are underrepresented in clinical trials, and real-world data on treatment patterns and outcomes in this population are limited. We aimed to assess treatment patterns, survival outcomes, and the role of performance status in treatment selection among patients aged ≥70 years with metastatic pancreatic cancer. Methods: We conducted a retrospective chart review of patients aged ≥70 years diagnosed with metastatic pancreatic cancer at our institution between 01/01/2013 and 12/31/2023. The primary endpoint was overall survival from diagnosis. Secondary endpoints included variables such as treatment utilization, next-generation sequencing (NGS) test rates, and palliative care referral patterns. Results: Mean age at diagnosis was 75.1 years (standard deviation (SD) 4.4); 68.3% were male. Race was 85.4% Caucasian, 2.4% Black, and 12.2% other; 7.3% were Hispanic. ECOG was most commonly 1 (17/41, 41.5%). The liver was the most common metastatic site (31/41, 75.6%), followed by lungs (13/41, 31.7%). Prior localized non-pancreatic cancer was present in 24.4% (10/41), there were no prior metastatic diseases. Pathologic confirmation occurred in 92.7% (38/41), and 58.5% (24/41) received systemic therapy, initiated a mean 21.1 days post-diagnosis (SD 18.0). Among treated patients, FOLFIRINOX was most common (13/24, 54.2%). Second-line therapy was given in 50% (12/24), and third-line in 25% (6/24). Among treated patients, 75% (18/24) had ECOG ≤2; 25% (6/24) undocumented. Among untreated patients, 35.3% (6/17) had ECOG ≤2, 29.4% (5/17) ECOG ≥3, and 35.3% (6/17) undocumented. Surgical or minimally invasive procedures were performed in 31.7% (13/41), most commonly biliary stenting/drainage (76.9%, 10/13). NGS was performed in 17% (7/41), including one patient before 2019 and the remainder in or after 2019; among treated patients, 25% (6/24) underwent NGS. Median time from diagnosis to death was 98 days (Interquartile Range (IQR) 35-369), compared with 185 days (IQR 75.5-486) in treated patients and 29.5 days (IQR 17.3-64.3) in untreated patients, a statistically significant difference (p = 0.0003; hazard ratio 0.3, 95% Confidence Interval 0.1–0.8). Only 48.8% (20/41) were referred to palliative care; death data were unavailable for 12 patients due to loss to follow-up or relocation, and these patients were censored at last follow-up. Conclusions: In this real-world cohort, elderly patients with metastatic pancreatic cancer who received systemic therapy had significantly longer survival than those who did not, consistent with potential treatment benefit in those with reasonable performance status. In patients diagnosed in or after 2019, only 6/25 had NGS, and palliative care referrals were also underutilized, representing quality improvement opportunities. No treated patient had ECOG ≥3, while nearly a third of untreated had ECOG ≥3, indicating performance status strongly influenced treatment decisions.