Abstract
416 Background: Over the last decade, various landmark trials have demonstrated the impact of multi-agent chemotherapy in the treatment of PDAC. However, the impact in the ‘real world’ has been less clear. The ACCORD trial (2011) was a phase III trial comparing combination chemotherapy (FOLFIRINOX) and single agent (gemcitabine) for advanced disease. The MPACT trial introduced another beneficial regimen (nab-paclitaxel and gemcitabine) in 2013. Subsequently, multi-agent chemotherapy became standard of care for medically appropriate patients. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with PDAC between 1998 and 2017. The cohort was divided into two groups: 1998-2011 (pre-ACCORD) and 2012-2017 (post-ACCORD). We analyzed all patients with metastatic PDAC for overall survival and compared results in the two groups using Kaplan Meier analysis and multivariate Cox proportional hazards models. An interrupted time series analysis was also used to compare the temporal trends in 2-year survival between 1998 and 2017. Results: A total of 47,134 patients were diagnosed with PDAC between 1998 and 2017. Nearly two-third of patients (26,438; 57%) had distant disease. On univariate survival analysis, there was a significant increased overall survival probability in the 2012-17 group compared to the 1998-2011 group (p<0.05). The one- and two-year survival rates were 11% and 3% in the pre-ACCORD period compared to 14% and 4 % after the ACCORD trial respectively. This difference remained significant on multivariate analysis while adjusting for covariates (HR=0.08, 0.78-0.92, p=0.05). On interrupted time series analysis, we observed a steady rise in 2- year survival between 1998 and 2017. There was a significant jump in the two-year survival probability from 16% at 2011 to 20% at 2012 in metastatic PDAC (β=0.02, 0.009-0.03, p<0.0001, Table). Conclusions: Beyond the randomized clinical trial arena, overall survival has increased over time, with a statistically significant jump around the time of the ACCORD trial. However, the absolute increase in the ‘real world’ is smaller than the gains observed in prospective clinical trials. [Table: see text]
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
