Abstract
Background: New chemotherapy regimens for the treatment of metastatic pancreatic cancer have changed the therapy paradigm. We aimed to assess their impact on the treatment landscape and clinical outcome at our academic institution. Methods: In this single institutional posthoc registry analysis, we assessed characteristics and survival rates from all patients with locally advanced and metastatic pancreatic cancer who started a systemic treatment between 01/2011 and 12/2017. Survival analyses were performed by Kaplan-Meier and Cox proportional hazards model. Results: A total of 301 patients started a systemic treatment in the observation period. In the first line treatment, we observed a shift from the four different main regimens (gemcitabine/nab-paclitaxel, modified FOLFIRINOX, gemcitabine/oxaliplatin +/− erlotinib or gemcitabine alone) to gemcitabine/nab-paclitaxel and modified FOLFIRINOX that add up to more than 80% of administered first line treatments in each of the time cohorts (2011–2013 vs. 2014–2017). The rate for first line modified FOLFIRINOX treatment was balanced between the two groups (19% and 15%). Median overall survival differed significantly between the two time cohorts (8.89 versus 11.9 months, p = 0.035). Survival rates for different first to second line treatment sequences (modified FOLFIRINOX to gemcitabine/nab-paclitaxel, gemcitabine/nab-paclitaxel to fluoropyrimidines plus nanoliposomal irinotecan, or gemcitabine/nab-paclitaxel to fluoropyrimidines plus oxaliplatin) were not significantly different and median overall survival ranged from 14.27 to 15.64 months. Conclusion: Our study provides real-world evidence for the effectiveness of the new chemotherapy regimens and underscores the importance of the choice of the front-line regimen when considering different sequencing strategies.
Highlights
Pancreatic ductal adenocarcinoma (PAC) is projected to become the second leading cause of cancer deaths in the United States, as well as Europe in the decade
In the first line treatment, we observed a shift from the four different main regimens to gemcitabine/nab-paclitaxel and modified FOLFIRINOX that add up to more than 80% of administered first line treatments in each of the time cohorts (2011–2013 vs. 2014–2017)
We compared the survival of patients who received a second line treatment with the most commonly used regimens (cohort A: 21% Gem/NabP, 14% Gem/(Cap)/Erlotinib, 14% FP/Ox; cohort B: 30% FP/Nal-IRI, 18% FP/Ox) and observed that there was a difference in survival time from first and second line treatment between the time cohorts. This survival benefit remained significant in the multivariate model when comparing patients who have been treated with the most commonly used second line regimens of the respective time cohorts (HR 0.56, CI 0.34–0.94, p = 0.029). These results suggest, that a change in treatment patterns, in particular that Gem/NabP moved from the second and third line to the first line setting in the later cohort and that FP/Nal-IRI was introduced as an effective second line regimen, was responsible for the observed survival benefit at our institution
Summary
Pancreatic ductal adenocarcinoma (PAC) is projected to become the second leading cause of cancer deaths in the United States, as well as Europe in the decade. The five-year survival rate of pancreatic cancer ranges between~5 to 10% with no raising numbers within the last 20 years [4]. New chemotherapy regimens for the treatment of metastatic pancreatic cancer have changed the therapy paradigm. Methods: In this single institutional posthoc registry analysis, we assessed characteristics and survival rates from all patients with locally advanced and metastatic pancreatic cancer who started a systemic treatment between 01/2011 and 12/2017. Median overall survival differed significantly between the two time cohorts (8.89 versus 11.9 months, p = 0.035). Survival rates for different first to second line treatment sequences (modified FOLFIRINOX to gemcitabine/nab-paclitaxel, gemcitabine/nab-paclitaxel to fluoropyrimidines plus nanoliposomal irinotecan, or gemcitabine/nab-paclitaxel to fluoropyrimidines plus oxaliplatin) were not significantly different and median overall survival ranged from 14.27 to 15.64 months. Conclusion: Our study provides real-world evidence for the effectiveness of the new chemotherapy regimens and underscores the importance of the choice of the front-line regimen when considering different sequencing strategies
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