Zusammenfassung
Das duktale Adenokarzinom des Pankreas ist eine Erkrankung des älteren Menschen, nahezu 2/3 aller neudiagnostizierten Fälle ist über 65 Jahre alt. Gleichzeitig werden mit zunehmendem Alter immer weniger Patienten in randomisierte Studie eingebracht, so dass insbesondere für das Pankreaskarzinom nur sehr wenige Daten zu Therapie und Therapie assoziierten Toxizitäten des älteren Menschen vorliegen. Aufgrund der zum Teil schweren Symptomatik (Kachexie, Schmerzexazerbationen, Ileus etc.) und der infausten Prognose sind jedoch im klinischen Alltag rationale Therapiealgorithmen essentiell. Das Kapitel soll in diesem Zusammenhang einen kurzen Überblick über die vorliegende Literatur zur Therapie hoch betagter Pankreaskarzinompatienten geben.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Literatur
Bellera CA, Rainfray M et al (2012) Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol 23(8):2166–2172
Berger AK, Abel U et al (2014) Chemotherapy for advanced pancreatic adenocarcinoma in elderly patients (>/=70 years of age): a retrospective cohort study at the national center for tumor diseases Heidelberg. Pancreatology 14(3):211–215
Boeck S, Hoehler T et al (2008) Capecitabine plus oxaliplatin (CapOx) versus capecitabine plus gemcitabine (CapGem) versus gemcitabine plus oxaliplatin (mGemOx): final results of a multicenter randomized phase II trial in advanced pancreatic cancer. Ann Oncol 19(2):340–347
Burris HA 3rd, Moore MJ et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15(6):2403–2413
Callery MP, Chang KJ et al (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16(7):1727–1733
Casadei R, Zanini N et al (2006) Prognostic factors in periampullary and pancreatic tumor resection in elderly patients. World J Surg 30(11):1992–2001, Discussion 2002–1993
Chauffert B, Mornex F et al (2008) Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000-01 FFCD/SFRO study. Ann Oncol 19(9):1592–1599
Cohen HJ, Smith D et al (2016) Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy. Cancer 122:3865–3872
Conroy T, Desseigne F et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364(19):1817–1825
Finlayson E, Fan Z et al (2007) Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg 205(6):729–734
Fong Y, Blumgart LH et al (1995) Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg 222(4):426–434, Discussion 434–427
Frakes JM, Strom T et al (2015) Resected pancreatic cancer outcomes in the elderly. J Geriatr Oncol 6(2):127–132
Giordano G, De Vita F et al (2015) Analysis of activity, efficacy and safety of first line Nab Paclitaxel (Nab-P) and Gemcitabine (G) in advanced pancreatic cancer (APDAC) frail and elderly patients (pts). Eur J Cancer 51(3):445
Goldstein und El-Maraghi (2015) Nab-Paclitaxel plus gemcitabine for metastatic pancreatic cancer: long-term survival from a phase III trial. J Natl Cancer Inst 107(2). Epub 02-02-2015. ISSN:1460-2105 (Electronic), 0027-8874 (Linking). https://doi.org/10.1093/jnci/dju413
Gunturu KS, Yao X et al (2013) FOLFIRINOX for locally advanced and metastatic pancreatic cancer: single institution retrospective review of efficacy and toxicity. Med Oncol 30(1):361
Hammel P, Huguet F et al (2016) Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the LAP07 randomized clinical trial. JAMA 315(17):1844–1853
Heek NT van, Kuhlmann KF et al (2005) Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg 242(6):781–788, Discussion 788–790
Hentic O, Dreyer C et al (2011) Gemcitabine in elderly patients with advanced pancreatic cancer. World J Gastroenterol 17(30):3497–3502
Higuera O, Ghanem I et al (2016) Management of pancreatic cancer in the elderly. World J Gastroenterol 22(2):764–775
Ho V, Heslin MJ (2003) Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg 237(4):509–514
Huguet F, Andre T et al (2007) Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol 25(3):326–331
Ito Y, Kenmochi T et al (2011) The impact of surgical outcome after pancreaticoduodenectomy in elderly patients. World J Surg Oncol 9:102
James (2014) Interim analysis of a phase II study of dose-modified FOLFIRINOX (mFOLFIRINOX) in locally advanced (LAPC) and metastatic pancreatic cancer (MPC). J Clin Oncol 32(Suppl 3):e15226
Katopodis O, Polyzos A et al (2011) Second-line chemotherapy with capecitabine (Xeloda) and docetaxel (Taxotere) in previously treated, unresectable adenocarcinoma of pancreas: the final results of a phase II trial. Cancer Chemother Pharmacol 67(2):361–368
Kotwall CA, Maxwell JG et al (2002) National estimates of mortality rates for radical pancreaticoduodenectomy in 25,000 patients. Ann Surg Oncol 9(9):847–854
Mangano DT, Goldman L (1995) Preoperative assessment of patients with known or suspected coronary disease. N Engl J Med 333(26):1750–1756
Marechal R, Demols A et al (2008) Tolerance and efficacy of gemcitabine and gemcitabine-based regimens in elderly patients with advanced pancreatic cancer. Pancreas 36(3):e16–e21
Moore MJ (2013) Prognostic factors (PFs) of survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel (nab-P) plus gemcitabine (G) versus G alone in patients (pts) with metastatic pancreatic cancer (MPC). J Clin Oncol 31(suppl, abstr 4059)
Moore MJ, Goldstein D et al (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the national cancer institute of Canada clinical trials group. J Clin Oncol 25(15):1960–1966
Nagrial AM, Chang DK et al (2014) Adjuvant chemotherapy in elderly patients with pancreatic cancer. Br J Cancer 110(2):313–319
Nakai Y, Isayama H et al (2011) Comorbidity, not age, is prognostic in patients with advanced pancreatic cancer receiving gemcitabine-based chemotherapy. Crit Rev Oncol Hematol 78(3):252–259
Neoptolemos JP, Stocken DD et al (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304(10):1073–1081
Neoptolemos JP, Moore MJ et al (2012) Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA 308(2):147–156
Niess H, Kleespies A et al (2013) Pancreatic cancer in the elderly: guidelines and individualized therapy. Chirurg 84(4):291–295
Oettle H, Neuhaus P et al (2013) Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA 310(14):1473–1481
Peddi PF, Lubner S et al (2012) Multi-institutional experience with FOLFIRINOX in pancreatic adenocarcinoma. JOP 13(5):497–501
Peixoto RD, Ho M et al (2015) Eligibility of metastatic pancreatic cancer patients for first-line palliative intent nab-Paclitaxel plus gemcitabine versus FOLFIRINOX. Am J Clin Oncol [Epub]
Riall TS (2009) What is the effect of age on pancreatic resection? Adv Surg 43:233–249
Riall TS, Sheffield KM et al (2011) Resection benefits older adults with locoregional pancreatic cancer despite greater short-term morbidity and mortality. J Am Geriatr Soc 59(4):647–654
Seufferlein T, Adler G (2009) The S3 guideline exocrine pancreatic cancer. Med Klin (Munich) 104(11):869–874
Seufferlein T, Porzner M et al (2013) S3-guideline exocrine pancreatic cancer. Z Gastroenterol 51(12):1395–1440
Shaib WL, Ip A et al (2016) Contemporary management of borderline resectable and locally advanced unresectable pancreatic cancer. Oncologist 21(2):178–187
Siegel R, Ma J et al (2014) Cancer statistics, 2014. CA Cancer J Clin 64(1):9–29
Talarico L, Chen G et al (2004) Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US food and drug administration. J Clin Oncol 22(22):4626–4631
Vickers MM, Powell ED et al (2012) Comorbidity, age and overall survival in patients with advanced pancreatic cancer – results from NCIC CTG PA.3: a phase III trial of gemcitabine plus erlotinib or placebo. Eur J Cancer 48(10):1434–1442
Wang-Gillam A, Li CP et al (2016) Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet 387(10018):545–557
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2018 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature
About this chapter
Cite this chapter
Härtel, N., Rückert, F. (2018). Pankreaskarzinom beim alten und geriatrischen Patienten. In: Ebert, M., Härtel, N., Wedding, U. (eds) Geriatrische Onkologie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48727-3_26
Download citation
DOI: https://doi.org/10.1007/978-3-662-48727-3_26
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-48726-6
Online ISBN: 978-3-662-48727-3
eBook Packages: Medicine (German Language)