Real-world patterns of care among patients with metastatic pancreatic cancer (mPC).

Abstract

666 Background: Pancreatic cancer is the third deadliest cancer in the US and mPC has a 2.9% 5-year survival. The analyses herein describe treatment patterns, trends in usage, and overall survival (OS) in mPC. Methods: Using the Flatiron Health EHR-derived database, data were extracted and analyzed for patients with mPC (pts) between Jan 1, 2014 and Jun 30, 2019. The database includes de-identified data from over 280 cancer clinics (~800 sites of care) representing more than 2.2 million U.S. cancer patients available for analysis, with 80% of pts from community centers and 20% from academic centers. Lines of therapy in the metastatic setting are derived from structured medication records. OS from metastatic diagnosis was reported using the Kaplan-Meier method. Results: 7,666 pts with mPC were identified. 5,687 (74.2%) received therapy in the metastatic setting. Pts who didn’t receive therapy in the metastatic setting were more likely to be older (p < 0.0001) and less likely to have been diagnosed initially with stage IV disease (p < 0.0001) than pts who were treated. The frequency of (1L) regimens were gemcitabine plus nab-paclitaxel (GnP) 46.8%, FOLFIRINOX (FFX) 24.1%, gemcitabine monotherapy 9.3%, and FOLFOX 3.8%. Gemcitabine monotherapy use was 12.9% in 2014 and 7.3% in 2018. GnP (31.4%), FFX (12.3%), FOLFOX (11.4%), and liposomal irinotecan (nal-IRI) + 5-FU/LV (10.2%) were the most frequent second line (2L) regimens. Between 2015 and 2018 nal-IRI based regimens increased from 6% to 17.6% in 2L. In the third line (3L) setting nal-IRI + 5FU/LV (19.3%), GnP (12.1%), FOLFOX (11.4%), and FFX (9.1%) were the most common treatments. Aggregate median OS (mOS) for treated pts was 8.1 mos (95% CI 7.8 – 8.4), and mOS for untreated pts was 2.8 mos (2.6 – 3.0), p < 0.0001. Conclusions: Survival for mPC is improving and practice patterns are changing. GnP is the most commonly used 1L regimen, followed increasingly by nal-IRI + 5-FU/LV in 2L and 3L. Further studies are necessary to understand the treatment gaps for pts with mPC. [Table: see text]