At first glance, Collineau's findings seem to be predictable: FOLFIRINOX is toxic, and OAs are vulnerable. But the deeper issue is whether we are asking the right question. By focusing narrowly on which OA can endure FOLFIRINOX, we risk missing the more relevant point: what is the most tolerable approach to the care of OAs with PDAC, and who truly benefits?
The Edison analogy is instructive here. His lasting legacy was not the brightest bulb, but the system that made light usable, safe, and enduring. In PDAC, the lesson is similar: the discovery of an intense regimen is useless unless it is embedded in a system that makes treatment tolerable and meaningful for patients. For OAs, that grid is built through geriatric assessment (GA), supportive interventions (nutrition, prehabilitation, psychosocial support), and integration of palliative care.
From “Who Can Tolerate” to “Who Will Benefit”
It is time for all of us to reimagine PDAC care in OA. The central question is no longer “who can tolerate FOLFIRINOX,” but “who will truly benefit?” Answering that requires
1.
Routine GA to uncover vulnerabilities
2.
Supportive interventions (comorbidity management, exercise, psychosocial support, nutritional support, and palliative integration) to enhance resilience
3.
Trial designs that embed tolerability and quality of life as end points that complement response and survival
4.
Exploration of objective aging biomarkers (inflammation, senescence, aging clocks, sarcopenia) for future stratification
Really important perspective from Ramy Sedhom on FOLFIRINOX in #panCAN patients >70 years old ("OA"). Even in selected patients who receive this intensive regimen, even w/ preemptive dose reductions, 56% G3 AE or unplanned hospitalization.
ascopubs.org/doi/10.1200/... #JCOOP #GIOnc