Real-world evidence of the efficacy and safety of first-line chemotherapy gemcitabine and nab-paclitaxel for elderly patients with metastatic pancreatic cancer

INTRODUCTION: Metastatic pancreatic cancer (mPC) is a highly aggressive disease associated with elevated rates of morbidity and mortality, and long-term survival remains poor. New therapeutic options, such as gemcitabine plus nab-paclitaxel (GEM-NAB), demonstrate statistically significant improvements in both overall survival (OS) and progression-free survival (PFS). Evidence-based data regarding the management of mPC in the elderly population remain limited. MATERIAL AND METHODS: This retrospective study analyzed a total of 245 patients with mPC treated with first-line GEM-NAB between February 2017 and January 2025. Of these, 143 (58.4%) were aged ≥ 65 years, including 88 (61.5%) women and 55 (38.5%) men. RESULTS: The median PFS was 6.07 months (95% CI: 5.24–6.89), and the median OS was 9.33 months (95% CI 8.64–10.03). The most common adverse events (AEs) were anemia, fatigue, neutropenia, peripheral neu­ropathy, and thrombocytopenia. No significant differences in the safety profile were observed between the older and younger patient groups; notably, the incidence of grade 4 toxicities was comparable. Dose modifications were required in 69.2% of cases to effectively manage AEs. Alcohol consumption and CEA levels were identified as independent prognostic factors for both OS and PFS. CONCLUSIONS: Our findings demonstrate that GEM-NAB is a safe and effective regimen for elderly patients in good clinical condition. Proactive dose modifications are essential to maintain treatment tolerability without compromising efficacy.