Observational Study of Clinical Practice in Patients with Pancreatic Adenocarcinoma in Greece.

George Papaxoinis,Michail Nikolaou,Davide Mauri,Ioannis Boukovinas,Maria Drizou,Suzana Stojanovska,Iliada Bompolaki,Nikolaos Tsoukalas,Joseph Sgouros,Gerasimos Aravantinos,Ioannis Varthalitis,Nikolaos Xenidis,Emmanouil Kontopodis,Athina Christopoulou,Georgios Oikonomopoulos,Anna Koumarianou,Dimitrios Doufexis,Anastastios Visvikis,Panagiotis Katsaounis,A Athanasiadis ,Alexandros Ioannou ,G Lypas ,Michalis Liontos ,Ippokratis Korantzis

doi:10.1155/2020/5304516

Abstract

Background During the last decade, significant improvement was made in systemic therapy of pancreatic adenocarcinoma (PAC). The impact of this progress in everyday clinical practice has not been fully described yet. The aim of the study was to investigate the pattern followed by Greek Medical Oncologists regarding the treatment of patients with PAC. Methods This observational, noninterventional multicenter study recorded clinical data from the files of 200 active patients (alive and under treatment or follow-up) for a two-year period (November 2015 until November 2017) from 20 oncology centers around Greece. Results In total, 51 (25.5%) patients underwent radical surgical resection of PAC, and 40 (78.4%) of them received adjuvant and 1 (2.0%) neoadjuvant chemotherapy. The median time to recurrence was 7.9 months, and median overall survival (OS), 20.2 months. First-line chemotherapy was administered to 193 (96.5%) patients. The majority of patients were treated with the combination of nab-paclitaxel-gemcitabine (NPG), 5-fluorouracil, leucovorin, irinotecan, oxaliplatin (FOLFIRINOX), or gemcitabine monotherapy. Of them, 39.5% responded to the treatment. Median OS and PFS were 14.1 months and 7.0 months, respectively. Second-line treatment was administered to 112 patients. The majority received NPG, FOLFIRINOX/capecitabine, oxaliplatin, irinotecan (CAPOXIRI), or 5-fluorouracil, leucovorin, oxaliplatin (FOLFOX)/capecitabine, oxaliplatin (CAPOX). Median OS with second-line treatment was 8.6 months, and median PFS, 5.5 months. The most common chemotherapy sequences were NPG as first-line followed by FOLFIRINOX/CAPOXIRI as second-line, NPG followed by FOLFOX/CAPOX, NPG followed by other regimens, and FOLFIRINOX/CAPOXIRI followed by NPG. Conclusion This study described the significant improvement in prognosis of PAC patients receiving palliative chemotherapy and the relatively high rate of receipt of second-line chemotherapy, according to real-world data. However, due to the nonrandomized nature of the study, any comparison between different chemotherapy regimens should be regarded with caution.

Highlights

Pancreatic cancer is a common neoplasm in the Western world, with ductal adenocarcinoma representing the dominant histology [1]
Median overall survival (OS) with secondline treatment was 8.6 months, and median PFS, 5.5 months. e most common chemotherapy sequences were NPG as first-line followed by FOLFIRINOX/CAPOXIRI as second-line, NPG followed by FOLFOX/CAPOX, NPG followed by other regimens, and FOLFIRINOX/CAPOXIRI followed by NPG
The vast majority of patients were diagnosed with ductal adenocarcinoma, while the rest were diagnosed with rare histological subtypes, such as acinar cell, adenosquamous, squamous, and noncystic mucinous carcinoma

Summary

Introduction

Pancreatic cancer is a common neoplasm in the Western world, with ductal adenocarcinoma representing the dominant histology [1]. 15–20% of PAC cases are surgically resectable Even these patients experience high relapse rate and poor prognosis [1]. Systemic therapy of locally advanced or metastatic PAC underwent a slow progress during the last 2 decades with only few randomized trials, showing a small benefit in median survival from 4.4 months with 5FU to 5.6 months with gemcitabine [7], 8.5 months with nab-paclitaxel-gemcitabine (NPG) [8], and 11.1 months with irinotecan-oxaliplatin-5FU-leucovorin (FOLFIRINOX) [9]. 51 (25.5%) patients underwent radical surgical resection of PAC, and 40 (78.4%) of them received adjuvant and 1 (2.0%) neoadjuvant chemotherapy. Is study described the significant improvement in prognosis of PAC patients receiving palliative chemotherapy and the relatively high rate of receipt of second-line chemotherapy, according to realworld data. Due to the nonrandomized nature of the study, any comparison between different chemotherapy regimens should be regarded with caution

Objectives

Methods

Results