Pankreaskarzinom beim alten und geriatrischen Patienten

Chapter
Part of the Springer Reference Medizin book series (SRM)

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.

Literatur

  1. Bellera CA, Rainfray M et al (2012) Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol 23(8):2166–2172CrossRefPubMedGoogle Scholar
  2. 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):211–215CrossRefPubMedGoogle Scholar
  3. 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):340–347CrossRefPubMedGoogle Scholar
  4. 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):2403–2413CrossRefPubMedGoogle Scholar
  5. Callery MP, Chang KJ et al (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16(7):1727–1733CrossRefPubMedGoogle Scholar
  6. 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 2002–1993CrossRefPubMedGoogle Scholar
  7. 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):1592–1599CrossRefPubMedGoogle Scholar
  8. 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 122:3865–3872CrossRefPubMedPubMedCentralGoogle Scholar
  9. Conroy T, Desseigne F et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364(19):1817–1825CrossRefPubMedGoogle Scholar
  10. Finlayson E, Fan Z et al (2007) Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg 205(6):729–734CrossRefPubMedGoogle Scholar
  11. 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 434–427CrossRefPubMedPubMedCentralGoogle Scholar
  12. Frakes JM, Strom T et al (2015) Resected pancreatic cancer outcomes in the elderly. J Geriatr Oncol 6(2):127–132CrossRefPubMedGoogle Scholar
  13. 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):445CrossRefGoogle Scholar
  14. 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
  15. 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):361CrossRefPubMedGoogle Scholar
  16. 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):1844–1853CrossRefPubMedGoogle Scholar
  17. 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 788–790Google Scholar
  18. Hentic O, Dreyer C et al (2011) Gemcitabine in elderly patients with advanced pancreatic cancer. World J Gastroenterol 17(30):3497–3502CrossRefPubMedPubMedCentralGoogle Scholar
  19. Higuera O, Ghanem I et al (2016) Management of pancreatic cancer in the elderly. World J Gastroenterol 22(2):764–775CrossRefPubMedPubMedCentralGoogle Scholar
  20. Ho V, Heslin MJ (2003) Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg 237(4):509–514PubMedPubMedCentralGoogle Scholar
  21. 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):326–331CrossRefPubMedGoogle Scholar
  22. Ito Y, Kenmochi T et al (2011) The impact of surgical outcome after pancreaticoduodenectomy in elderly patients. World J Surg Oncol 9:102CrossRefPubMedPubMedCentralGoogle Scholar
  23. 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):e15226Google Scholar
  24. 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):361–368CrossRefPubMedGoogle Scholar
  25. Kotwall CA, Maxwell JG et al (2002) National estimates of mortality rates for radical pancreaticoduodenectomy in 25,000 patients. Ann Surg Oncol 9(9):847–854CrossRefPubMedGoogle Scholar
  26. Mangano DT, Goldman L (1995) Preoperative assessment of patients with known or suspected coronary disease. N Engl J Med 333(26):1750–1756CrossRefPubMedGoogle Scholar
  27. 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–e21CrossRefPubMedGoogle Scholar
  28. 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)Google Scholar
  29. 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):1960–1966CrossRefPubMedGoogle Scholar
  30. Nagrial AM, Chang DK et al (2014) Adjuvant chemotherapy in elderly patients with pancreatic cancer. Br J Cancer 110(2):313–319CrossRefPubMedGoogle Scholar
  31. 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):252–259CrossRefPubMedGoogle Scholar
  32. 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):1073–1081CrossRefPubMedGoogle Scholar
  33. 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):147–156CrossRefPubMedGoogle Scholar
  34. Niess H, Kleespies A et al (2013) Pancreatic cancer in the elderly: guidelines and individualized therapy. Chirurg 84(4):291–295CrossRefPubMedGoogle Scholar
  35. 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):1473–1481CrossRefPubMedGoogle Scholar
  36. Peddi PF, Lubner S et al (2012) Multi-institutional experience with FOLFIRINOX in pancreatic adenocarcinoma. JOP 13(5):497–501PubMedGoogle Scholar
  37. 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]Google Scholar
  38. Riall TS (2009) What is the effect of age on pancreatic resection? Adv Surg 43:233–249CrossRefPubMedPubMedCentralGoogle Scholar
  39. 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):647–654CrossRefPubMedPubMedCentralGoogle Scholar
  40. Seufferlein T, Adler G (2009) The S3 guideline exocrine pancreatic cancer. Med Klin (Munich) 104(11):869–874CrossRefGoogle Scholar
  41. Seufferlein T, Porzner M et al (2013) S3-guideline exocrine pancreatic cancer. Z Gastroenterol 51(12):1395–1440CrossRefPubMedGoogle Scholar
  42. Shaib WL, Ip A et al (2016) Contemporary management of borderline resectable and locally advanced unresectable pancreatic cancer. Oncologist 21(2):178–187CrossRefPubMedPubMedCentralGoogle Scholar
  43. Siegel R, Ma J et al (2014) Cancer statistics, 2014. CA Cancer J Clin 64(1):9–29CrossRefPubMedGoogle Scholar
  44. 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):4626–4631CrossRefPubMedGoogle Scholar
  45. 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):1434–1442CrossRefPubMedGoogle Scholar
  46. 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):545–557CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.II. Medizinische KlinikUniversitätsmedizin Mannheim, Mannheim und Abt. Gastroenterologie und Onkologie, Heilig-Geist Hospital BensheimBensheimDeutschland
  2. 2.Chirurgische KlinikUniversitätsmedizin MannheimMannheimDeutschland

Section editors and affiliations

  • Nicolai Härtel
    • 1
  1. 1.Interdisziplinäres TumorzentrumUniversitätsmedizin MannheimMannheimDeutschland

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