TY - JOUR
T1 - First- and Second-Line Palliative Systemic Treatment Outcomes in a Real-World Metastatic Pancreatic Cancer Cohort
AU - Pijnappel, E.N.
AU - Dijksterhuis, W.P.M.
AU - van der Geest, L.G.
AU - de Vos-Geelen, J.
AU - de Groot, J.W.B.
AU - Homs, M.Y.V.
AU - Creemers, G.J.
AU - Mohammad, N.H.
AU - Besselink, M.G.
AU - van Laarhoven, H.W.M.
AU - Wilmink, J.W.
AU - Dutch Pancreatic Canc Grp
N1 - Funding Information:
Disclosures: Dr. de Vos-Geelen has disclosed receiving nonfinancial and institutional research support from Servier, and serving as an advisory board member for Amgen, AstraZeneca, MSD, Pierre Fabre, and Servier. Dr. de Groot has disclosed serving as an advisory board member for BMS and MSD. Dr. Hohammad has disclosed serving as a scientific advisor for Servier, Merck, Eli Lilly, and BMS, and receiving grant/research support from Servier. Dr. van Laarhoven has disclosed serving as a consultant for BMS, Celgene, Lilly, MSD/Merck, Nordic Pharma, and Servier; receiving unrestricted research funding from Bayer, BMS, Celgene, Lilly, Merck Serono, MSD, Nordic, Philips, Roche, and Servier; and serving as a consultant for BMS, Lilly, MSD, Nordic Pharma, and Servier. Dr. Wilmink has disclosed serving as a consultant for Shire, Servier, and Celgene; receiving grant support from Servier, Halozyne, Novartis, Celgene, AstraZeneca, Pfizer, Roche, Amgen, and MSD/Merck; and serving as an advisory board member for Servier, Celgene, MSD/Merck, and Novartis. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Publisher Copyright:
© 2022 Harborside Press. All rights reserved.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background: Metastatic pancreatic ductal adenocarcinoma (PDAC) is characterized by a poor survival rate, which can be improved by systemic treatment. Consensus on the most optimal first- and second-line palliative systemic treatment is lacking. The aim of this study was to describe the use of first- and second-line systemic treatment, overall survival (OS), and time to failure (TTF) of first- and second-line treatment in metastatic PDAC in a real-world setting. Patients and Methods: Patients with synchronous metastatic PDAC diagnosed between 2015 and 2018 who received systemic treatment were selected from the nationwide Netherlands Cancer Registry. OS and TTF were evaluated using Kaplan-Meier curves with log-rank test and multivariable Cox proportional hazard analyses. Results: The majority of 1,586 included patients received FOLFIRINOX (65%), followed by gemcitabine (18%), and gemcitabine 1 nabpaclitaxel (13%) in the first line. Median OS for first-line FOLFIRINOX, gemcitabine 1 nab-paclitaxel, and gemcitabine monotherapy was 6.6, 4.7, and 2.9 months, respectively. Compared to FOLFIRINOX, gemcitabine 1 nab-paclitaxel showed significantly inferior OS after adjustment for confounders (hazard ratio [HR], 1.20; 95% CI, 1.02-1.41), and gemcitabine monotherapy was independently associated with a shorter OS and TTF (HR, 1.98; 95% CI, 1.71-2.30 and HR, 2.31; 95% CI, 1.88-2.83, respectively). Of the 121 patients who received second-line systemic treatment, 33% received gemcitabine 1 nab-paclitaxel, followed by gemcitabine (31%) and FOLFIRINOX (10%). Conclusions: Based on population-based data in patients with metastatic PDAC, treatment predominantly consists of FOLFIRINOX in the first line and gemcitabine with or without nab-paclitaxel in the second line. FOLFIRINOX in the first line shows superior OS compared with gemcitabine with or without nab-paclitaxel.
AB - Background: Metastatic pancreatic ductal adenocarcinoma (PDAC) is characterized by a poor survival rate, which can be improved by systemic treatment. Consensus on the most optimal first- and second-line palliative systemic treatment is lacking. The aim of this study was to describe the use of first- and second-line systemic treatment, overall survival (OS), and time to failure (TTF) of first- and second-line treatment in metastatic PDAC in a real-world setting. Patients and Methods: Patients with synchronous metastatic PDAC diagnosed between 2015 and 2018 who received systemic treatment were selected from the nationwide Netherlands Cancer Registry. OS and TTF were evaluated using Kaplan-Meier curves with log-rank test and multivariable Cox proportional hazard analyses. Results: The majority of 1,586 included patients received FOLFIRINOX (65%), followed by gemcitabine (18%), and gemcitabine 1 nabpaclitaxel (13%) in the first line. Median OS for first-line FOLFIRINOX, gemcitabine 1 nab-paclitaxel, and gemcitabine monotherapy was 6.6, 4.7, and 2.9 months, respectively. Compared to FOLFIRINOX, gemcitabine 1 nab-paclitaxel showed significantly inferior OS after adjustment for confounders (hazard ratio [HR], 1.20; 95% CI, 1.02-1.41), and gemcitabine monotherapy was independently associated with a shorter OS and TTF (HR, 1.98; 95% CI, 1.71-2.30 and HR, 2.31; 95% CI, 1.88-2.83, respectively). Of the 121 patients who received second-line systemic treatment, 33% received gemcitabine 1 nab-paclitaxel, followed by gemcitabine (31%) and FOLFIRINOX (10%). Conclusions: Based on population-based data in patients with metastatic PDAC, treatment predominantly consists of FOLFIRINOX in the first line and gemcitabine with or without nab-paclitaxel in the second line. FOLFIRINOX in the first line shows superior OS compared with gemcitabine with or without nab-paclitaxel.
KW - GEMCITABINE
KW - FOLFIRINOX
KW - SURVIVAL
KW - CARE
KW - FLUOROURACIL
KW - CHEMOTHERAPY
KW - ONCOLOGY
U2 - 10.6004/jnccn.2021.7028
DO - 10.6004/jnccn.2021.7028
M3 - Article
C2 - 34450595
SN - 1540-1405
VL - 20
SP - 443
EP - 450
JO - Journal of the National Comprehensive Cancer Network
JF - Journal of the National Comprehensive Cancer Network
IS - 5
ER -