Second-line (2L) treatment patterns and clinical outcomes among real-world (RW) patients (pts) with metastatic pancreatic ductal adenocarcinoma (mPDAC) treated with FOLFIRINOX (FFX) or gemcitabine + nab-paclitaxel (GnP) in the first-line (1L).

Abstract

e16322 Background: FFX and GnP are the most common 1L treatments for pts with mPDAC. Approximately half of pts treated with these regimens continue to 2L, though optimal 2L treatment is unclear. We identified a RW sample of mPDAC pts treated with 1L FFX or GnP and assessed their 2L treatment patterns, duration of therapy (DoT), overall survival (OS), and time to next treatment (TTNT). Methods: This retrospective observational study utilized the Ontada Clinical Data View: Pancreatic Cancer database. Adult pts diagnosed with mPDAC between November 2018 and November 2021 who initiated 1L treatment with FFX or GnP ≤90 days from metastatic diagnosis date were included. To observe 2L treatment patterns, pts were required to have ≥1 year of follow-up unless death occurred first. Pts were censored at date of last activity absent death. Kaplan-Meier analyses were used to assess the median OS and TTNT from the start of 1L. Pts were grouped into five treatment categories: 1L FFX-only, 1L FFX + 2L GnP, 1L FFX + 2L other, 1L GnP-only, and 1L GnP + any 2L. Pts with 2L treatments were not restricted by whether they received 3L therapy or later. Results: 936 1L GnP and 712 1L FFX pts met the study inclusion criteria. 572 (61%) 1L GnP pts received 1L GnP-only and 364 (39%) received 1L GnP + any 2L (“any 2L” included 78 Nal-IRI, 59 FOLFOX, 57 FFX pts, and 170 pts with various combinations of chemotherapies and/or targeted therapies, with < 50 pts per regimen). 300 (42%) 1L FFX pts received 1L FFX-only, 287 (40%) received 1L FFX + 2L GnP, and 125 (18%) received 1L FFX + 2L other (“2L other” included 35 capecitabine monotherapy pts, 27 G monotherapy pts, all other regimens < 20 pts). Pts with 1L FFX were younger, slightly more likely to be male, and had slightly better ECOG scores than 1L GnP pts. Median 1L DoT was shorter for 1L-only pts compared to pts with 2L therapies. Median OS was shortest for 1L-only pts and longest for 1L FFX + 2L other. Median OS was similar for 1L FFX + 2L GnP and 1L GnP + any 2L. Median TTNT was similar across treatment categories with a 2L. Conclusions: In a RW sample of mPDAC pts, those with 1L-only had poor survival. Pts with 1L FFX + 2L GnP had a similar survival to 1L GnP + any 2L. [Table: see text]