Garcia Gwenalyn, Odaimi Marcel
Division of Hematology/Oncology, Department of Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA.
J Gastrointest Cancer. 2017 Jun;48(2):121-128. doi: 10.1007/s12029-017-9930-0.
In recent years, significant progress in survival has been achieved using systemic combination chemotherapy in patients with pancreatic cancer. However, the elderly are largely underrepresented in clinical trials, and gains made from these may not necessarily apply to this important subgroup of patients. We review the currently available data regarding contemporary combination chemotherapy regimens, including FOLFIRINOX, gemcitabine plus nab-paclitaxel, nanoliposomal irinotecan plus 5-fluorouracil and leucovorin, and gemcitabine plus capecitabine, in elderly pancreatic cancer patients.
We performed a search of Pubmed using the terms "pancreatic cancer", "elderly", "FOLFIRINOX", "gemcitabine", "nab-paclitaxel", "capecitabine", and "nanoliposomal irinotecan" and included articles investigating the use of combination chemotherapy in the elderly with pancreatic adenocarcinoma. Relevant abstracts from American Society of Clinical Oncology and European Society of Medical Oncology meetings were included.
Current clinical evidence and experience suggests that relatively fit elderly pancreatic cancer patients may derive significant benefit from contemporary combination chemotherapy regimens. Strategies to improve tolerability without decreasing efficacy include dose reduction, schedule modification, and growth factor support. Phase III clinical trials are ongoing to determine the optimal use of combination chemotherapy regimens in elderly patients with pancreatic cancer.
Identifying elderly patients who will benefit from combination chemotherapy for pancreatic cancer remains a significant clinical challenge. An assessment of medical comorbidities and functional status plays a key role in determining fitness for intensive chemotherapeutic regimens in this important subset of patients.
近年来，胰腺癌患者采用全身联合化疗在生存率方面取得了显著进展。然而，老年人在临床试验中的比例严重不足，而且这些试验所取得的成果不一定适用于这一重要的患者亚组。我们回顾了目前关于当代联合化疗方案的可用数据，这些方案包括FOLFIRINOX、吉西他滨加纳米白蛋白结合型紫杉醇、纳米脂质体伊立替康加5-氟尿嘧啶和亚叶酸钙，以及吉西他滨加卡培他滨，用于老年胰腺癌患者。
我们在PubMed上使用“胰腺癌”“老年人”“FOLFIRINOX”“吉西他滨”“纳米白蛋白结合型紫杉醇”“卡培他滨”和“纳米脂质体伊立替康”等关键词进行检索，并纳入研究联合化疗在老年胰腺腺癌患者中应用的文章。还纳入了美国临床肿瘤学会和欧洲医学肿瘤学会会议的相关摘要。
目前的临床证据和经验表明，身体状况相对较好的老年胰腺癌患者可能从当代联合化疗方案中获得显著益处。在不降低疗效的情况下提高耐受性的策略包括剂量减少、方案调整和生长因子支持。正在进行III期临床试验以确定联合化疗方案在老年胰腺癌患者中的最佳应用。
确定哪些老年胰腺癌患者将从联合化疗中获益仍然是一项重大的临床挑战。评估医疗合并症和功能状态在确定这一重要患者亚组是否适合强化化疗方案方面起着关键作用。
