Since 2011, new systemic therapy combinations, FOLFIRINOX and nab-paclitaxel with gemcitabine, have demonstrated improvements in survival for PDAC. It is unclear if the availability of these therapies have changed referral patterns or the uptake of systemic treatment in the Canadian context, or improved real world outcomes.
We performed a population-based analysis of patients with a biopsy-proven unresectable/metastatic PDAC from 2009-2016 in Alberta, Canada. The primary outcome was overall survival (OS) of patients who received chemotherapy, pre and post 2011, while controlling for relevant patient and disease characteristics. Secondary outcomes include the proportion of patients referred to a cancer centre, and receipt of systemic treatment in a universal health care system.
A total of 1764 patients with PDAC were identified, with a median age of 70, 51% male, 86% metastatic disease and 59% occurring in the head or neck. 485 patients were diagnosed prior to 2011 while 1279 were diagnosed after. Rates of cancer centre referrals after 2011 increased from 44 to 50% (p = 0.03), but there was no difference in the use of initial chemotherapy (26 vs 28%, p = 0.44). Use of single agent regimens decreased (81% to 53%) in favour of combination therapy (p
The natural history of PDAC remains very poor, despite advances in systemic therapy. The majority of patients are not receiving systemic chemotherapy, highlighting the need for improvements in diagnosis and referral, even in a universal health care system. There are no modern trials comparing best supportive care to modern chemotherapy, and this population-based study demonstrates a real-world benchmark for improving patient outcomes.
Clinical trial identification
Legal entity responsible for the study
Tom Baker Cancer Centre
R. Lee-Ying: Advisory board: Celgene. W.Y. Cheung: Advisory Celgene: Shire. P. Tang: Advisory Board: Celgene, Shire. All other authors have declared no conflicts of interest.