P-338 Advanced pancreatic adenocarcinoma in daily clinical practice: A single-center experience

Abstract

Pancreatic adenocarcinoma (AC) is a systemic disease with early metastatic spread and poor survival rate. Palliative chemotherapy (CT) is the treatment of choice for advanced stages. Also, palliative surgical and endoscopic techniques are meant to improve quality of life and make the patient more comfortable. Moreover, the majority of pancreatic cancer patients present with pain at the time of diagnosis. Pain management can be challenging in light of the aggressive nature of this cancer. The aim of this study was to evaluate the oncological approach to advanced pancreatic ductal AC in daily clinical practice. We conducted a retrospective analysis of all patients diagnosed with pancreatic AC treated at our Medical Oncology Department between 2008 and 2016, then we analyzed the cohort of patients with metastatic disease. We evaluated gender, clinical history, performance status (ECOG), tumour location, tumour stage, biliary stent, albumin rate, white blood cell rate, liver function, and treatment approach. Univariate analysis for OS was estimated using the Kaplan-Meier method with statistical significance (p < 0.05) of differences evaluated by log-rank test. Cox regression model was carried out for multivariate analysis. All statistical analysis was performed using SPSS version 25.0. 114 patients were identified; 43% female and 57% male; median age at diagnosis was 63.3 years (range 41-111). All patients had AC histopathological type. We evaluated 78 patients (68,4%) with metastatic disease. They had a baseline ECOG performance status at cycle 1 of first-line CT of 1, 2, 3, 4 in 40%, 40%, 16%, 4% patients. The primary tumor was located in the head of the pancreas in 59,6% patients. T3 and T4 stages were found in 64,9% of patients. Liver/peritoneum/lymph node/lung/multiorgan metastases were present in 17/10/09/19/23 patients. Time to diagnosis was less than three months in 50.9% of patients. 21 patients had been treated for pain at baseline, and 22 had undergone biliary drainage prior to the initial CT. 60,3% of patients received CT. 58% of patients received first-line CT. The most used first-line CT regimen was gemcitabine (46,2%). Second-line CT was performed in 13 patients (16,7%), and 4 patients received third-line CT. The most used CT regimen in the 2nd and 3rd lines was capecitabine. The median overall survival (mOS) was 3,9 months (95% CI, 0.2-7.1) from diagnosis. mOS from diagnosis was 2.4 months (95% CI, 0.2-11.6) for patients who received 1 line only, 8.3 months (95% CI, 0.5-16.5) for patients who received 2 lines and 16.3 months (95% CI, 4.1-35.2) for those who received 3 lines. Univariate and multivariate analysis showed that ECOG PS (p = 0.002) was associated with poor prognosis. This retrospective analysis highlighted the prescribing profile of systemic CT at Algerian Tlemcen Hospital. We demonstrated poor overall survival of metastatic pancreatic cancer. Survival was poorest in those receiving a single line of CT. Patients should receive multiple sequences of chemotherapy whenever possible. We are aware of the limitations of a retrospective study. Further studies like these are needed to evaluate the management of advanced pancreatic cancer in real-world clinical practice.