Treatment strategies and clinical outcomes in consecutive patients with locally advanced pancreatic cancer: A multicenter prospective cohort

M.S. Walma; L.J. Brada; S.I.S. Patuleia; J.G. Blomjous; T.L. Bollen; K. Bosscha; R.C. Bruijnen; O.R. Busch; G.J. Creemers; F. Daams; R. van Dam; S. Festen; D.J. de Groot; J.W. de Groot; N.H. Mohammad; J.J. Hermans; I.H. de Hingh; E.D. Kerver; M.S. van Leeuwen; C. van der Leij; M.S. Liem; K.P. van Lienden; M. Los; V.E. de Meijer; M.R. Meijerink; L.J. Mekenkamp; J. Nederend; C.Y. Nio; G.A. Patijn; M.B. Polee; J.F. Pruijt; N.S. Renken; S.J. Rombouts; T.J. Schouten; M.W.J. Stommel; M.E. Verweij; J. de Vos-Geelen; J.J.J. de Vries; A. Vulink; F.J. Wessels; J.W. Wilmink; H.C. van Santvoort; M.G. Besselink; I.Q. Molenaar; Dutch Pancreatic Canc Grp

doi:10.1016/j.ejso.2020.11.137

Treatment strategies and clinical outcomes in consecutive patients with locally advanced pancreatic cancer: A multicenter prospective cohort

M.S. Walma, L.J. Brada, S.I.S. Patuleia, J.G. Blomjous, T.L. Bollen, K. Bosscha, R.C. Bruijnen, O.R. Busch, G.J. Creemers, F. Daams, R. van Dam, S. Festen, D.J. de Groot, J.W. de Groot, N.H. Mohammad, J.J. Hermans, I.H. de Hingh, E.D. Kerver, M.S. van Leeuwen, C. van der LeijM.S. Liem, K.P. van Lienden, M. Los, V.E. de Meijer, M.R. Meijerink, L.J. Mekenkamp, J. Nederend, C.Y. Nio, G.A. Patijn, M.B. Polee, J.F. Pruijt, N.S. Renken, S.J. Rombouts, T.J. Schouten, M.W.J. Stommel, M.E. Verweij, J. de Vos-Geelen, J.J.J. de Vries, A. Vulink, F.J. Wessels, J.W. Wilmink, H.C. van Santvoort, M.G. Besselink^*, I.Q. Molenaar, Dutch Pancreatic Canc Grp

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Introduction: 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. This study provides treatment strategies and clinical outcomes within a multicenter cohort of unselected patients with LAPC.Materials and methods: Consecutive 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.Results: Overall, 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).Conclusion: This 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. (C) 2020 The Authors. Published by Elsevier Ltd.

Original language	English
Pages (from-to)	699-707
Number of pages	9
Journal	European Journal of Surgical Oncology
Volume	47
Issue number	3
DOIs	https://doi.org/10.1016/j.ejso.2020.11.137
Publication status	Published - 1 Mar 2021

Keywords

folfirinox
locally advanced pancreatic cancer
treatment strategies
FOLFIRINOX
Locally advanced pancreatic cancer
Treatment strategies

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Walma, M. S., Brada, L. J., Patuleia, S. I. S., Blomjous, J. G., Bollen, T. L., Bosscha, K., Bruijnen, R. C., Busch, O. R., Creemers, G. J., Daams, F., van Dam, R., Festen, S., de Groot, D. J., de Groot, J. W., Mohammad, N. H., Hermans, J. J., de Hingh, I. H., Kerver, E. D., van Leeuwen, M. S., ... Dutch Pancreatic Canc Grp (2021). Treatment strategies and clinical outcomes in consecutive patients with locally advanced pancreatic cancer: A multicenter prospective cohort. European Journal of Surgical Oncology, 47(3), 699-707. https://doi.org/10.1016/j.ejso.2020.11.137

@article{580e6797f6a847f9ae95e66d4f9b92cd,

title = "Treatment strategies and clinical outcomes in consecutive patients with locally advanced pancreatic cancer: A multicenter prospective cohort",

abstract = "Introduction: 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. This study provides treatment strategies and clinical outcomes within a multicenter cohort of unselected patients with LAPC.Materials and methods: Consecutive 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.Results: Overall, 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).Conclusion: This 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. (C) 2020 The Authors. Published by Elsevier Ltd.",

keywords = "folfirinox, locally advanced pancreatic cancer, treatment strategies, FOLFIRINOX, Locally advanced pancreatic cancer, Treatment strategies",

author = "M.S. Walma and L.J. Brada and S.I.S. Patuleia and J.G. Blomjous and T.L. Bollen and K. Bosscha and R.C. Bruijnen and O.R. Busch and G.J. Creemers and F. Daams and {van Dam}, R. and S. Festen and {de Groot}, D.J. and {de Groot}, J.W. and N.H. Mohammad and J.J. Hermans and {de Hingh}, I.H. and E.D. Kerver and {van Leeuwen}, M.S. and {van der Leij}, C. and M.S. Liem and {van Lienden}, K.P. and M. Los and {de Meijer}, V.E. and M.R. Meijerink and L.J. Mekenkamp and J. Nederend and C.Y. Nio and G.A. Patijn and M.B. Polee and J.F. Pruijt and N.S. Renken and S.J. Rombouts and T.J. Schouten and M.W.J. Stommel and M.E. Verweij and {de Vos-Geelen}, J. and {de Vries}, J.J.J. and A. Vulink and F.J. Wessels and J.W. Wilmink and {van Santvoort}, H.C. and M.G. Besselink and I.Q. Molenaar and {Dutch Pancreatic Canc Grp}",

note = "Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JGB has received grants, personal fees and non-financial support from Biotronik outside the submitted work; JWdG has received personal fees outside the submitted work from Bristol-Myers Squibb, Roche, Pierre-Fabre, Servier, MSD, Novartis; NHM reports advisory board fees for her institution from BMS, Eli Lilly, Servier, and MSD; IdH reports grants from Roche Pharmaceutical, QPS/RanD, and Medtronic, outside the submitted work; KvL reports personal fees and non-financial support from AngioDynamics, outside the submitted work; VEdM reports grants from Stichting Louise Vehmeijer and NWO and travel grants from Astellas, and from Neovii, outside the submitted work; MRM reports grants, personal fees and non-financial support from Angiodynamics, grants and personal fees from Medtronic Covidien, and non-financial support from Cascination, outside the submitted work. JdVG reports grants and non-financial support from Servier, outside the submitted work; JWW reports research grants from Servier, Halozyme, Novartis, Celgene, Astra Zeneca, Pfizer, Roche, Amgen, Merck and a consulting/advisory role for Servier and Celgene; HCvS has received a research grant from the Dutch Cancer Society, during and outside the submitted work; MGB has received a research grant from the Dutch Cancer Society during and outside the conduct of the study. IQM has received a research grant from the Dutch Cancer Society during the conduct of the study. For all other authors, there are no conflicts of interest. Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JGB has received grants, personal fees and non-financial support from Biotronik outside the submitted work; JWdG has received personal fees outside the submitted work from Bristol-Myers Squibb , Roche , Pierre-Fabre, Servier , MSD, Novartis; NHM reports advisory board fees for her institution from BMS, Eli Lilly, Servier, and MSD; IdH reports grants from Roche Pharmaceutical, QPS/RanD, and Medtronic, outside the submitted work; KvL reports personal fees and non-financial support from AngioDynamics, outside the submitted work; VEdM reports grants from Stichting Louise Vehmeijer and NWO and travel grants from Astellas, and from Neovii, outside the submitted work; MRM reports grants, personal fees and non-financial support from Angiodynamics, grants and personal fees from Medtronic Covidien, and non-financial support from Cascination, outside the submitted work. JdVG reports grants and non-financial support from Servier , outside the submitted work; JWW reports research grants from Servier , Halozyme , Novartis , Celgene , Astra Zeneca, Pfizer , Roche , Amgen , Merck and a consulting/advisory role for Servier and Celgene; HCvS has received a research grant from the Dutch Cancer Society, during and outside the submitted work; MGB has received a research grant from the Dutch Cancer Society during and outside the conduct of the study. IQM has received a research grant from the Dutch Cancer Society during the conduct of the study. For all other authors, there are no conflicts of interest. Funding Information: This work was supported by the Dutch Cancer Society [grant number 2014–7244]. The Dutch Cancer Society did not have any role in the design of the study, collection and analysis of data and decision to publish. Publisher Copyright: {\textcopyright} 2020 The Authors",

year = "2021",

month = mar,

day = "1",

doi = "10.1016/j.ejso.2020.11.137",

language = "English",

volume = "47",

pages = "699--707",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "ELSEVIER SCI LTD",

number = "3",

}

Walma, MS, Brada, LJ, Patuleia, SIS, Blomjous, JG, Bollen, TL, Bosscha, K, Bruijnen, RC, Busch, OR, Creemers, GJ, Daams, F, van Dam, R, Festen, S, de Groot, DJ, de Groot, JW, Mohammad, NH, Hermans, JJ, de Hingh, IH, Kerver, ED, van Leeuwen, MS, van der Leij, C, Liem, MS, van Lienden, KP, Los, M, de Meijer, VE, Meijerink, MR, Mekenkamp, LJ, Nederend, J, Nio, CY, Patijn, GA, Polee, MB, Pruijt, JF, Renken, NS, Rombouts, SJ, Schouten, TJ, Stommel, MWJ, Verweij, ME, de Vos-Geelen, J, de Vries, JJJ, Vulink, A, Wessels, FJ, Wilmink, JW, van Santvoort, HC, Besselink, MG, Molenaar, IQ & Dutch Pancreatic Canc Grp 2021, 'Treatment strategies and clinical outcomes in consecutive patients with locally advanced pancreatic cancer: A multicenter prospective cohort', European Journal of Surgical Oncology, vol. 47, no. 3, pp. 699-707. https://doi.org/10.1016/j.ejso.2020.11.137

TY - JOUR

T1 - Treatment strategies and clinical outcomes in consecutive patients with locally advanced pancreatic cancer: A multicenter prospective cohort

AU - Walma, M.S.

AU - Brada, L.J.

AU - Patuleia, S.I.S.

AU - Blomjous, J.G.

AU - Bollen, T.L.

AU - Bosscha, K.

AU - Bruijnen, R.C.

AU - Busch, O.R.

AU - Creemers, G.J.

AU - Daams, F.

AU - van Dam, R.

AU - Festen, S.

AU - de Groot, D.J.

AU - de Groot, J.W.

AU - Mohammad, N.H.

AU - Hermans, J.J.

AU - de Hingh, I.H.

AU - Kerver, E.D.

AU - van Leeuwen, M.S.

AU - van der Leij, C.

AU - Liem, M.S.

AU - van Lienden, K.P.

AU - Los, M.

AU - de Meijer, V.E.

AU - Meijerink, M.R.

AU - Mekenkamp, L.J.

AU - Nederend, J.

AU - Nio, C.Y.

AU - Patijn, G.A.

AU - Polee, M.B.

AU - Pruijt, J.F.

AU - Renken, N.S.

AU - Rombouts, S.J.

AU - Schouten, T.J.

AU - Stommel, M.W.J.

AU - Verweij, M.E.

AU - de Vos-Geelen, J.

AU - de Vries, J.J.J.

AU - Vulink, A.

AU - Wessels, F.J.

AU - Wilmink, J.W.

AU - van Santvoort, H.C.

AU - Besselink, M.G.

AU - Molenaar, I.Q.

AU - Dutch Pancreatic Canc Grp

N1 - Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JGB has received grants, personal fees and non-financial support from Biotronik outside the submitted work; JWdG has received personal fees outside the submitted work from Bristol-Myers Squibb, Roche, Pierre-Fabre, Servier, MSD, Novartis; NHM reports advisory board fees for her institution from BMS, Eli Lilly, Servier, and MSD; IdH reports grants from Roche Pharmaceutical, QPS/RanD, and Medtronic, outside the submitted work; KvL reports personal fees and non-financial support from AngioDynamics, outside the submitted work; VEdM reports grants from Stichting Louise Vehmeijer and NWO and travel grants from Astellas, and from Neovii, outside the submitted work; MRM reports grants, personal fees and non-financial support from Angiodynamics, grants and personal fees from Medtronic Covidien, and non-financial support from Cascination, outside the submitted work. JdVG reports grants and non-financial support from Servier, outside the submitted work; JWW reports research grants from Servier, Halozyme, Novartis, Celgene, Astra Zeneca, Pfizer, Roche, Amgen, Merck and a consulting/advisory role for Servier and Celgene; HCvS has received a research grant from the Dutch Cancer Society, during and outside the submitted work; MGB has received a research grant from the Dutch Cancer Society during and outside the conduct of the study. IQM has received a research grant from the Dutch Cancer Society during the conduct of the study. For all other authors, there are no conflicts of interest. Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JGB has received grants, personal fees and non-financial support from Biotronik outside the submitted work; JWdG has received personal fees outside the submitted work from Bristol-Myers Squibb , Roche , Pierre-Fabre, Servier , MSD, Novartis; NHM reports advisory board fees for her institution from BMS, Eli Lilly, Servier, and MSD; IdH reports grants from Roche Pharmaceutical, QPS/RanD, and Medtronic, outside the submitted work; KvL reports personal fees and non-financial support from AngioDynamics, outside the submitted work; VEdM reports grants from Stichting Louise Vehmeijer and NWO and travel grants from Astellas, and from Neovii, outside the submitted work; MRM reports grants, personal fees and non-financial support from Angiodynamics, grants and personal fees from Medtronic Covidien, and non-financial support from Cascination, outside the submitted work. JdVG reports grants and non-financial support from Servier , outside the submitted work; JWW reports research grants from Servier , Halozyme , Novartis , Celgene , Astra Zeneca, Pfizer , Roche , Amgen , Merck and a consulting/advisory role for Servier and Celgene; HCvS has received a research grant from the Dutch Cancer Society, during and outside the submitted work; MGB has received a research grant from the Dutch Cancer Society during and outside the conduct of the study. IQM has received a research grant from the Dutch Cancer Society during the conduct of the study. For all other authors, there are no conflicts of interest. Funding Information: This work was supported by the Dutch Cancer Society [grant number 2014–7244]. The Dutch Cancer Society did not have any role in the design of the study, collection and analysis of data and decision to publish. Publisher Copyright: © 2020 The Authors

PY - 2021/3/1

Y1 - 2021/3/1

N2 - Introduction: 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. This study provides treatment strategies and clinical outcomes within a multicenter cohort of unselected patients with LAPC.Materials and methods: Consecutive 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.Results: Overall, 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).Conclusion: This 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. (C) 2020 The Authors. Published by Elsevier Ltd.

AB - Introduction: 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. This study provides treatment strategies and clinical outcomes within a multicenter cohort of unselected patients with LAPC.Materials and methods: Consecutive 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.Results: Overall, 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).Conclusion: This 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. (C) 2020 The Authors. Published by Elsevier Ltd.

KW - folfirinox

KW - locally advanced pancreatic cancer

KW - treatment strategies

KW - FOLFIRINOX

KW - Locally advanced pancreatic cancer

KW - Treatment strategies

U2 - 10.1016/j.ejso.2020.11.137

DO - 10.1016/j.ejso.2020.11.137

M3 - Article

C2 - 33280952

SN - 0748-7983

VL - 47

SP - 699

EP - 707

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 3

ER -