e16385 Background: Randomized trials supporting first-line chemotherapy for metastatic pancreatic cancer have systematically underrepresented very old adults. As a result, the comparative effectiveness of intensive chemotherapy in patients aged ≧75 years remains uncertain in routine clinical practice. Methods: We conducted a retrospective cohort study using the TriNetX multinational electronic health record database. Patients aged ≧75 years with metastatic pancreatic cancer receiving first-line FOLFIRINOX or gemcitabine plus nab-paclitaxel (GnP) were identified. 1:1 propensity score matching (PSM) was performed to balance demographics, comorbidities, metastatic site, and baseline laboratory markers including albumin, total bilirubin and CA19-9. The primary outcome was overall survival (OS). Secondary outcomes included time to next treatment or death (TTNT-D), 6-month OS rate, and acute healthcare utilization (ER and acute inpatient visits). Results: After matching, 274 patients were included in each group. First-line FOLFIRINOX was associated with significantly longer OS compared with GnP (median OS: 11.4 vs 9.7 months; HR 0.82, 95% CI 0.666–0.999, log-rank P = 0.048). The 6-month OS rate was notably higher with FOLFIRINOX (70.3% vs. 59.2%; HR 0.68, 95% CI 0.49-0.93). TTNT-D showed a consistent trend (median: 6.94 vs. 6.28 months; HR 0.857, 95% CI 0.709-1.036). Importantly, acute healthcare utilization did not differ significantly between FOLFIRINOX and GnP groups (35.6% vs 27.1%, p = 0.224). Conclusions: In this large-scale real-world cohort of patients aged ≧75 years with metastatic pancreatic cancer, first-line FOLFIRINOX demonstrated a significant survival advantage over GnP and improved early survival outcomes without a statistically significant increase in acute healthcare utilization. This study provides evidence to support FOLFIRINOX as a viable front-line option for fit older adults.
Wei-Tong Liao (Thu,) studied this question.