Abstract
IntroductionSince current studies on locally advanced pancreatic cancer (LAPC) mainly report from single, high-volume centers, it is unclear if outcomes can be translated to daily clinical practice. This study provides treatment strategies and clinical outcomes within a multicenter cohort of unselected patients with LAPC. Materials and methodsConsecutive patients with LAPC according to Dutch Pancreatic Cancer Group criteria, were prospectively included in 14 centers from April 2015 until December 2017. A centralized expert panel reviewed response according to RECIST v1.1 and potential surgical resectability. Primary outcome was median overall survival (mOS), stratified for primary treatment strategy. ResultsOverall, 422 patients were included, of whom 77% (n = 326) received chemotherapy. The majority started with FOLFIRINOX (77%, 252/326) with a median of six cycles (IQR 4–10). Gemcitabine monotherapy was given to 13% (41/326) of patients and nab-paclitaxel/gemcitabine to 10% (33/326), with a median of two (IQR 3–5) and three (IQR 3–5) cycles respectively. The mOS of the entire cohort was 10 months (95%CI 9–11). In patients treated with FOLFIRINOX, gemcitabine monotherapy, or nab-paclitaxel/gemcitabine, mOS was 14 (95%CI 13–15), 9 (95%CI 8–10), and 9 months (95%CI 8–10), respectively. A resection was performed in 13% (32/252) of patients after FOLFIRINOX, resulting in a mOS of 23 months (95%CI 12–34). ConclusionThis multicenter unselected cohort of patients with LAPC resulted in a 14 month mOS and a 13% resection rate after FOLFIRINOX. These data put previous results in perspective, enable us to inform patients with more accurate survival numbers and will support decision-making in clinical practice.
Highlights
Since current studies on locally advanced pancreatic cancer (LAPC) mainly report from single, high-volume centers, it is unclear if outcomes can be translated to daily clinical practice
Nab-paclitaxel/gemcitabine was administered as first-line treatment to 10% of patients (33/326) with a median of two cycles (IQR 2e5), and 13% (41/326) of patients starting chemotherapy received gemcitabine monotherapy with a median of three cycles (IQR 2e5)
Patients treated with FOLFIRINOX were significantly younger, had a lower Charlson comorbidity Index, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and CA19-9 and a higher albumin level at diagnosis when compared to other groups (Table 1)
Summary
Since current studies on locally advanced pancreatic cancer (LAPC) mainly report from single, high-volume centers, it is unclear if outcomes can be translated to daily clinical practice. Conclusion: This multicenter unselected cohort of patients with LAPC resulted in a 14 month mOS and a 13% resection rate after FOLFIRINOX. High-volume expert centers report resection rates of approximately 28% after FOLFIRINOX, with a very promising median overall survival (mOS) up to 35 months [6,8,9]. These studies, are subject to referral bias and inclusion criteria of oncological trials are often limited to patients with favorable performance status, carrying the risk of sampling bias [10,11]. The external validity of these results for the overall population of patients with newly diagnosed LAPC is uncertain so that translation of these promising results into daily clinical practice is unclear
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