1676P - Clinical outcomes of first-line chemotherapy in locally advanced and metastatic pancreatic adenocarcinoma patients: Real-world experience

Background

Pancreatic cancer has a poor prognosis compared to many other malignancies. This study evaluated the clinical outcomes of systemic chemotherapy (CMT) in patients with locally advanced and metastatic pancreatic ductal adenocarcinoma (LA/M-PDAC).

Methods

A retrospective, observational chart review was conducted on patients with LA/M-PDAC who underwent CMT between January 2012 and November 2022. The efficacy data (objective response rate [ORR], disease-control rate [DCR], progression-free survival [PFS], and overall survival [OS]) were evaluated and compared using Pearson’s chi-square tests, Kaplan–Meier plots, and log-rank tests.

Results

Out of the 998 patients diagnosed with LA/M-PDAC, 332 (33.3%) received systemic CMT. Among the treatment regimens used, gemcitabine (GEM) was administered most frequently (33.7% of cases). The next most commonly utilized therapies were (m)FOLFIRINOX and GEM plus capecitabine (GEMCAPE), accounting for 27.4% and 26.2% of cases, respectively. Platinum doublets (PlatD) were administered in 9.3% of cases. The ORRs and DCRs of the four regimens differed significantly (for GEM, GEMCAPE, (m)FOLFIRINOX, and PlatD, the ORRs were 4.5%, 10.3%, 23.1%, 19.4%, respectively, with P < 0.0001; the DCRs were 38.4%, 52.9%, 73.6%, and 54.8%, respectively, with P < 0.0001). Patients who received combination CMTs had significantly longer median PFSs than those who received GEM alone (PFS = 4.93 months for GEMCAPE, 9 months for (m)FOLFIRINOX, 9.43 months for PlatD, and 3.87 months for GEM). When comparing GEMCAPE with (m)FOLFIRINOX, the median PFS was significantly lower in the GEMCAPE group (PFS = 4.93 vs 9.0 months; HR = 0.53; P < 0.0001). However, no significant differences were observed in the median OS rates of the four regimens in a multivariate Cox proportional-hazards model analysis. The frequency of treatment-related grade 3 or 4 adverse events was higher in the (m)FOLFIRINOX group, followed by the GEMCAPE group.

Conclusions

This study revealed that FOLFIRINOX exhibited higher ORR, DCR, and PFS rates than GEM or GEMCAPE. Nevertheless, no survival advantage was detected in the FOLFIRINOX groups, suggesting the influence of subsequent therapies.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

K. Korphaisarn: Financial Interests, Personal, Invited Speaker: Roche, Amgen, AstraZeneca, MSD; Non-Financial Interests, Principal Investigator: MSD, Roche. All other authors have declared no conflicts of interest.