P-106 Descriptive study of long-term survivors with advanced pancreatic cancer

Abstract

Advanced pancreatic cancer (PC) has a grim prognosis, with a 5-year survival rate less than 5%. Long-term survivors with advanced PC are not defined and the literature on the subject is scarce and based mainly in isolated clinical cases. In the post-hoc analysis of the MPACT study, 4% of patients treated with gemcitabine plus nab-paclitaxel (GNP) lived more than 3 years (1). In the PRODIGE study, 18.6% of patients had a survival over 18 months (2). A surgical series describes 2% of survivors > 5 years (3). We present characteristics of long-term survivors of PC, as well as tumor characteristics, treatments, and results obtained. This observational and descriptive study of patients with advanced PC in the province of Huelva, in the period between 2012 and 2020, considered long-term survivors (> 2.5 years). Statistical analysis was performed using the IBM SPSS Statistics 22 program. 8 patients were selected, 7 metastatic and 1 locally advanced. 75% males, median age 64 years. 87.5% with ECOG 1 were not diabetic and had not previously presented hepatitis or pancreatitis. 62.5% smoked and 25% had excessive alcohol consumption. No patient had a family history of cancer. 87.5% were diagnosed in stage IV and 12.5 in stage III. Histological grade 2 in 87.5%, and vascular-lymphatic invasion in 50%. 75% were located in the body and body/tail. At diagnosis, 37.5% had elevated lactate dehydrogenase (LDH) and 12.5% had decreased albumin levels. 50% showed elevation of Ca 19.9 and the neutrophil-lymphocyte ratio (NLR) was higher than 3 in 37.5%. 50% of patients had ≥ 2 affected organs (12.5% > 3 organs). 37.5% liver metastases, 12.5%, peritoneal metastases, 50% lung metastases, 50% lymph node metastases. A biliary stent was placed in 25%. No patient had thrombosis during the course of the disease. 50% of patients underwent surgery and received neoadjuvant/adjuvant therapies. 62.5% received radiotherapy. 62.5% patients received first-line GNP treatment. 37.5% patients showed a complete response (CR) and 50% a partial response (PR) as the best response (BR) to the first-line treatment. The median progression-free survival (PFS1) was 15.5 months (95% CI; 13.7 - 17.2). 62.5% received GNP in the second-line treatment, as a new regimen or retreatment. The BR to the second-line treatment: 37.5% PR. The median progression-free survival (PFS2) was 5.29 months (95% CI; 1.15 - 9.42). 62.5% of the patients received third-line treatment. 37.5% capecitabine-oxaliplatin, 12.5% irinotecan and 12.5% GNP. The BR to the third-line: 25% PR and 37.5% stable disease (SD). The median overall survival (OS) was 40.5 months (95% CI; 38.53 - 42.48). 3 patients are still alive with a median follow-up of 31.4 months. We highlight in our series the unusual evolution with a median OS greater than 3 years, as well as the high percentage of complete responses and the high efficiency with retreatments. We must investigate the molecular characteristics to explain these results. We believe it is the first European series of patients with long-term survivors of PC with promising results including only advanced disease.