Role of routine prognostic blood tests in evaluating chances of safely prolonged survival across all ages.

Abstract

e16348 Background: Prognostic blood tests (PBTs) are independent predictors of survival and often outperform traditional clinical prognostic characteristics (CPCs). Low-dose chemotherapy may safely prolong survival in patients with a performance status of 0-2. Methods: Consecutive patients with advanced stage IV pancreatic cancer and performance status 0–2, either treatment-naïve or previously treated with 2 (1-3) standard multi-drug regimens, were administered one-third standard doses of gemcitabine and FOLFIRINOX. Upon progression, docetaxel and mitomycin C were added. Survival was evaluated using Kaplan–Meier and Cox regression analyses. Predefined cut points included age (> 70, > 65 years) and baseline PBTs, summarized by the A.L.A.N. score (0–2 favorable vs ≥3 unfavorable), incorporating serum albumin ( < 3.5 g/dL), neutrophil-to-lymphocyte ratio (> 3), lymphocyte-to-monocyte ratio ( < 2.1), and absolute neutrophil count ( > 8). Ideal cut points (ICP) were also assessed. All patients provided written informed consent, with IRB approval, FDA, and ClinicalTrials.gov registration. Results: Across all ages, favorable PBT subgroups comprised 70–85% of patients, including 53 treatment-naïve and 53 previously treated individuals. Median survival times ranged from 12 to 20 months, with 2-year survival rates of 20–38%, and no hospitalizations, treatment-limiting toxicities, or withdrawals. Median survival for patients aged < 70 versus ≥70 years, 40 patients, was 12.5 versus 12.8 months, with 2-year survival of 21.4% versus 27.5% (p = 0.36). For patients aged < 65 versus ≥65 years, 66 patients, median survival was 12.1 versus 12.6 months, with 2-year survival of 16% versus 30% (p = 0.056). PBTs demonstrated strong prognostic significance: A.L.A.N. score (p < 10⁻⁹), serum albumin (p < 10⁻⁷), absolute neutrophil count (p < 10⁻⁶), neutrophil-to-lymphocyte ratio (p < 10⁻³), and lymphocyte-to-monocyte ratio (p = 0.04). Ideal cut points further strengthened associations. No interaction was observed between age and individual PBTs (p = 0.44). Conclusions: Independent of age (55–80 years), or unfavorable PBTs, A.L.A.N. scores of 0–2 identify a substantial subset of patients, including a potentially doubling proportion of elderly individuals, with actionable survival exceeding 12 months and excellent safety using economical low-dose chemotherapy. Systematic archiving and use of PBTs may expand opportunities for geriatric oncology research, including treatment safety, substantially sparing hospitalizations, low-dose strategies, recombination and rechallenge approaches, enhanced geriatric evaluation tools, and targeted investigation of immune-mediated or host-cell resistance mechanisms. Clinical trial information: 119005 .