Journal of Digestive Cancer Research

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
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Safety and Efficacy of Gemcitabine Based Chemotherapy in Elderly Patients with Advanced Pancreatic Cancer - Safety of Gemcitabine in Elderly

진행성 췌장암을 가진 노인환자에서 Gemcitabine 항암화학요법의 안정성과 효과 - 노인에서 Gemcitabine의 안정성 -

  • You Ie Choi (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Dong Uk Kim (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Jae Hoon Cheong (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Bong Eun Lee (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Gwang Ha Kim (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Geun Am Song (Department of Internal Medicine, Pusan National University School of Medicine)
  • 최유이 (부산대학교 의학전문대학원 내과학교실) ;
  • 김동욱 (부산대학교 의학전문대학원 내과학교실) ;
  • 정재훈 (부산대학교 의학전문대학원 내과학교실) ;
  • 이봉은 (부산대학교 의학전문대학원 내과학교실) ;
  • 김광하 (부산대학교 의학전문대학원 내과학교실) ;
  • 송근암 (부산대학교 의학전문대학원 내과학교실)
  • Received : 2012.11.01
  • Accepted : 2012.11.22
  • Published : 2013.03.31
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Abstract

Background/Aims: Gemcitabine is regarded as a reference regimen for advanced pancreatic cancer and shows relatively safe toxicity profiles compared with other cytotoxic agents. However, many oncologists are appeared to be still reluctant to treat elderly pancreatic cancer patients with cytotoxic chemotherapy because of predicted low response rate and potential adverse events. Methods: All patients who were received gemcitabine based chemotherapy between 2007 and 2010 were identified and clinical, laboratory, radiographic data were retrospectively reviewed. Patients were divided into two groups based on their ages: less than 65, and equal or more than 65 years old. Gemcitabine, at a dose of 1,000 mg per square meter of body surface area, was administered by intravenously over 30 minutes weekly for 3 weeks followed by 1 week rest, alone or along with other chemotherapeutic agents including cisplatin, capecitabine and erlotinib. Results: A total of 61 patients were identified and all patients were not eligible to receive operation because of advanced stage at diagnosis. Twenty three patients (37.7%) were equal or more than 65 year of age. Mean age was 56 years old and 71 years old in each group. Laboratory data including CA 19-9 were not significantly different. More gemcitabine monotherapy was delivered (56.5% vs. 26.3%, p=0.029) and less second or third line therapy was adminis- tered (17.4% vs. 50.0%, p=0.014) in elderly group. Cholangitis occurred and stent placement were performed similarly in both groups. Conclusion: Gemcitabine based chemotherapy can be administered safely to elderly pancreatic cancer patients and comparable response rate and progression free survival can be expected as young patients.

배경 및 목적: Gemcitabine은 진행성 췌장암 환자의 치료에 우선적으로 사용되며, 다른 항암 약제에 비하여 상대적으로 독성이 적은 것으로 알려져 있다. 그러나 약제의 낮은 반응률과 상대적으로 높은 합병증의 발생률 때문에 많은 소화기암을 다루는 의사들은 췌장암을 가진 노인환자에서 항암치료를 꺼려하는 경항이 있다. 방법: 2007년에서 2010년 사이에 조직학적으로 췌장암을 진단받고, gemcitabine 항암요법을 시행받은 61명의 환자를 후향적으로 임상적, 검사실 및 영상학적 자료를 분석하였다. 환자는 65세 이상군 28명과 65세 미만군 38명으로 나누었다. Gemcitabine은 체표면적당 1,000 mg을 3주 동안 매주 30분에 걸쳐 투여하였고, 다른 항암제인 cisplatin, capecitabine, erlotinib 등을 병합 투여한 경우가 있었다. 결과: 환자의 평균 나이는 65세 이상군에서 71세, 65세 미만군에서 56세 였다. 진단 시 시행한 CA 19-9을 포함한 검사실검사는 두 군 간에 차이가 없었으며, gemcitabine 단독 항암요법을 시행한 경우는 65세 이상군에서 더 많았고(56.5 vs. 26.3%, p=0.029), 2차 혹은 3차 항암요법을 시행한 군은 65세 미만군에서 더 많았다(17.4 vs. 50.0%, p=0.014). 담관염이나 담관스텐트 유치는 양군에서 차이가 없었다. 결과: Gemcitabine 항암화학요법은 진행성 췌장암을 가진 노인환자에서 안전하게 사용할 수 있으며, 젊은 환자들에 견줄만한 치료 반응률과 무진행생존기간을 기대할 수 있을 것으로 예상된다.

Keywords

References

  1. Li J, Saif MW. Advancements in the management of pancreatic cancer. JOP 2009;10:109-117.
  2. Ferrone CR, Brennan MF, Gonen M, et al. Pancreatic adenocarcinom: the actual 5-year survivors. J Gastrointest Surg 2008;12:701-706.
  3. Chari ST. Detecting early pancreatic cancer: problems and prospects. Semin Oncol 2007;34:284-294.
  4. Burris HA, Moore MJ, Andersen J, et al. Imporvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997;15:2403-2413.
  5. Susan BR, Hyman BM. Adjuvant chemotherapy in the elderly: whom to treat, what regimen? The Oncologist 2006;11:234-42.
  6. Montamat SC, Cusack BJ, Vestal RE. Management of drug therapy in the elderly. N Engl J Med 1989;321:303-309.
  7. Robert j, Hoemi B. Age dependence of the early-phase pharmacokinetics of doxorubicin. Cancer Res 1983;43:4467-69.
  8. Fujiwara Y, Ohune T, Niitani K, et al. Clinical pharmacological profile of etoposide in the elderly. Proc Am Soc Clin Oncol 1996;15:174.
  9. Yamamoto N, Tamura T, Maeda M, et al. The influence of ageing on cisplatin pharmacokinetics in lung cancer patients with normal organ function. Cancer Chemother Pharmacol 1996;36:102-106.
  10. Milano G, Etienne MC, Thyss C-VA, et al. Influence of sex and age on fluorouracil clearance. J Clin Oncol 1992;10:1171-1175.
  11. Saif MW. Is there a standard of care for the management of advanced pancreatic cancer?: highlights from the gastrointestinal cancers symposium, Orlando, FL, USA. January 25-27, 2008. JOP 2008;9:91-98.
  12. Tempero M, Plunkett W, Ruiz van Haperen V, et al. Randomized phase II comparison of dose-intense gemcitabine: thirty-minute infusion and fixed dose rate infusion in patients with pancreatic adenocarcinoma. J Clin Oncol 2003;21:3402-3408.
  13. Berlin JD, Catalano P, Thomas JP, Kugler JW, Haller DG, Benson AB 3rd. Phase III study of gemcitabine in combination with fluorouracil versus gemcitabine alone in patients with advanced pancreatic carcinoma: Eastern Cooperative Oncology Group Trial E2297. J Clin Oncol 2002;20:3270-3275.
  14. Heinemann V, Quietzsch D, Gieseler F, et al. Randomized phase III trial of gemcitabine plus cisplatin compared with gemcitabine alone in advanced pancreatic cancer. J Clin Oncol 2006;24:3946-3952.
  15. Herrmann R, Bodoky G, Ruhstaller T, et al. Gemcitabine plus capecitabine compared with gemcitabine alone in advanced pancreatic cancer: a randomized, multicenter, phase III trial of the Swiss Group for Clinical Cancer Research and the Central European Cooperative Oncology Group. J Clin Oncol 2007;25:2212-2217.
  16. Moore MJ, Goldstein D, Hamm J, et al. 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 2007;25:1960-1966.
  17. Fukuoka M, Negoro S, Kudo S, et al. Gemcitabine late phase II cooperative study group A. Jpn J Cancer Chemother 1996;23:1825-1832.
  18. Yokoyama A, Nakai Y, Yoneda S, Kurita Y, Niitani H, Taguchi T. Gemcitabine cooperative study group B for late phase II. Jpn J Cancer Chemother 1996;23:1681-1688.
  19. Okada S, Ueno H, Okusaka, Ikeda M, Furuse J, Maru Y. Phase I trial of gemcitabine in patients with advanced pancreatic cancer. Jpn J Clin Oncol 2001;31:7-12.
  20. Yammamoto N. Non-small cell lung cancer a) Internal medicine. In: Clinical Oncology, 3rd ed. p535-560, Japan Society of Medical Oncology. Tokyo Cancer and Chemotherapy Publishers, 2003.
  21. Shaib W, Lansigan F, Cornfeld D, Syrigos K, Saif MW. Gemcitabine-Induced Pulmonary Toxicity During Adjuvant Therapy in a Patient with Pancreatic Cancer. JOP 2008;9:708-714.
  22. Hu CH, George L, Delclos, Chan W, Xianglin L. Assessing the initiation and completion of adjuvant chemotherapy in a large nationwide and population-based cohort of elderly patients with stage-III colon cancer. Medical Oncology 2011;28:1062-1074.