Relative Dose Intensity and Outcomes in Elderly Patients With Resectable Pancreatic Cancer Receiving Neoadjuvant Chemotherapy

BACKGROUND: Neoadjuvant chemotherapy (NAC) with gemcitabine and S-1 (GS) is the standard regimen for resectable pancreatic cancer (PC) in Japan. However, its efficacy in elderly patients and those with impaired renal function remains unclear. METHODS: We retrospectively analyzed patients with resectable PC who received NAC GS. Patients were classified as elderly (≥ 75 years) or non-elderly (< 75 years). The primary endpoint was relative dose intensity (RDI) of NAC. Secondary endpoints included adverse events (AEs), perioperative outcomes, RDI of adjuvant chemotherapy (AC), recurrence-free survival (RFS), and overall survival (OS). RESULTS: A total of 185 patients were included (non-elderly: 148, elderly: 37). Median creatinine clearance (CCr) was lower in elderly patients (64.2 vs. 84.5 mL/min, p < 0.001). Mean RDI of GS was significantly lower in elderly patients and those with CCr < 50 mL/min, particularly when both factors coexisted. Severe hematologic AEs were more frequent in these groups, though perioperative outcomes were similar. While initiation of AC was delayed and RDI of adjuvant S-1 was lower in elderly patients, RFS and OS did not significantly differ between groups. CONCLUSIONS: NAC GS appears feasible in elderly patients with resectable PC, though caution is needed in those with impaired renal function.