Safety and efficacy of combination chemotherapy regimens in older adults with pancreatic ductal adenocarcinoma: a systematic review

Abstract

Background: Pancreatic ductal adenocarcinoma (PDA) is often diagnosed in older adults. However, most published studies investigating chemotherapy for PDA include a predominantly younger population, and the standard of care for the older adult population is not defined. It is our goal to review the literature available about the safety and efficacy of combination chemotherapy for locally advanced or metastatic PDA in older adults ≥65 years. Methods: We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting checklist. We searched PubMed, EMBASE and MEDLINE databases to identify retrospective and prospective studies published until October 2018 that assessed the survival outcomes and adverse events in patients 65 years and older diagnosed with PDA and treated with combination chemotherapy. Results: A total of 1,479 studies were screened. Twenty-four full-text studies were assessed for eligibility. Nineteen were excluded due to wrong study design (n=4) or abstract only with no further publication (n=15). A total of 5 full text studies met eligibility and were included in the present review. Combination chemotherapy is associated with similar survival to that reported in younger populations with advanced PDA. The most common toxicities across studies included: sensory neuropathy and neutropenia. Two studies each reported one death related to treatment-associated sepsis. Discussion: Papers examined in this systematic review concluded that the use of combination chemotherapy regimens is safe and effective for older adults with minimal comorbidities and adequate performance status. Prospective data is needed to confirm these findings, provided that the most significant limitation of these studies was a small sample size.