For a long time gemcitabine (gem) has been the standard of care for patients with pancreatic ductal adenocarcinoma (PDAC). Recently, FOLFIRINOX and nab-paclitaxel/gemcitabine (nab-P/gem) were introduced showing significantly improved survival in clinical trials. This study aims to investigate the efficacy and tolerability of FOLFIRINOX and nab-P/gem versus gem monotherapy in real-life settings across different European institutions and to analyze the decision-making process among physicians administering these drugs.
634 patients from 8 centers with PDAC receiving palliative chemotherapy between 2012 and 2015 were included in a retrospective multinational study design. In an independent survey, a web-based questionnaire containing 15 questions regarding the use of different chemotherapy options in metastatic PDAC was distributed among 5420 doctors in 19 European countries.
Of the 634 included patients, 351 (55%) were male and 97 (15%) had been surgically resected before systemic recurrence. Gem treatment (monotherapy + /-capecitabine/cisplatin) was the regimen most commonly used in European centers (74%) as compared to FOLFIRINOX (9%) and nab-P/gem (3%). The median overall survival in different groups were: FOLFIRINOX 12.0m (95%CI8.5-15.5), nab-P/gem 7.0m (95%CI4.7-9.3) and gem monotherapy 5.0m (95%CI4.4-5.6). Only FOLFIRINOX was associated with improved survival as compared to gem monotherapy (p
Our retrospective cohort showed that gem therapy was still predominantly used. However, the pan-European questionnaire revealed a more frequent use of intensified regimens indicating an increasing acceptance among European physicians in 2015. Intensified regimens are widely available throughout Europe, but used variably in clinical routine dependent on hospital setting and country.
Clinical trial identification
Legal entity responsible for the study
Pancreas2000, an educational and research program for tomorrows pancreatologists in Europe.
All authors have declared no conflicts of interest.