Abstract 1526P
Background
Palliative systemic therapy is the only treatment option that can prolong survival in metastatic pancreatic ductal adenocarcinoma (mPDAC). The aim of the study was to assess the association between type of first and second line systemic therapy on overall survival (OS) and time to failure (TTF) in mPDAC using population-based data.
Methods
Patients with synchronous mPDAC diagnosed between 2015 and 2018 were selected from the Netherlands Cancer Registry (n=5859). OS and TTF were evaluated using Kaplan Meier curves with log-rank test and multivariable Cox proportional hazard analyses corrected for relevant patient and tumor characteristics.
Results
First-line systemic treatment was administered in 1573 patients (27%). Most patients received FOLFIRINOX (65%), followed by gemcitabine (18%) and gemcitabine+nab-paclitaxel (13%). The median OS (mOS) for first-line FOLFIRINOX, gemcitabine+nab-paclitaxel and gemcitabine monotherapy was 6.6, 4.7 and 2.9 months respectively. Compared to FOLFIRINOX, gemcitabine+nab-paclitaxel showed no significant inferior OS or TTF after adjustment for confounders (HR 1.19, 95% CI 1.00-1.40 and HR 1.29, 95% CI 0.83-1.99 respectively), while gemcitabine monotherapy was independently associated with a shorter OS and TTF (HR 1.95, 95% CI 1.67-2.27 and HR 2.76, 95% CI 2.07-3.69 respectively) in multivariable analyses. Second-line systemic treatment was administered in 244 patients, 42% received gemcitabine+nab-paclitaxel, followed by gemcitabine (25%) and FOLFIRINOX (11%). The mOS for FOLFIRINOX was 4.4 months. mOS was higher in patients that received gemcitabine+nab-paclitaxel compared to patients who received gemcitabine monotherapy in univariable (5.5 versus 4.4 months, P=0.014) and multivariable analyses (HR 0.72 CI 0.51-1.01).
Conclusions
Based on our population based data, first-line therapy with FOLFIRINOX and gemcitabine+nab-paclitaxel are the preferred treatment strategies. For second-line treatment gemcitabine+nab-paclitaxel showed the best survival rate. Our data does not contain definitive information about the optimal sequence strategy, future research should provide a conclusive answer.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
J. de vos-Geelen: Honoraria (institution), Non-remunerated activity/ies: Servier. N. Haj Mohammad: Advisory/Consultancy, Research grant/Funding (institution): Servier; Advisory/Consultancy: Merck; Advisory/Consultancy: Eli Lilly; Advisory/Consultancy: BMS. H.W.M. van Laarhoven: Advisory/Consultancy, Research grant/Funding (self): BMS; Advisory/Consultancy, Research grant/Funding (self): Celgene; Advisory/Consultancy, Research grant/Funding (self): Lilly; Advisory/Consultancy, Research grant/Funding (self): Merck; Advisory/Consultancy, Research grant/Funding (self): Nordic; Advisory/Consultancy, Research grant/Funding (self): Servier; Research grant/Funding (self): Bayer; Research grant/Funding (self): Serono; Research grant/Funding (self): MSD; Research grant/Funding (self): Philips; Research grant/Funding (self): Roche. H. Wilmink: Advisory/Consultancy, Research grant/Funding (self): Servier; Research grant/Funding (self): Halozyne; Research grant/Funding (self): Novartis; Advisory/Consultancy, Research grant/Funding (self): Celgene; Research grant/Funding (self): Astra Zeneca; Research grant/Funding (self): Roche; Research grant/Funding (self): Amgen; Research grant/Funding (self): Merck; Advisory/Consultancy: Shire; Research grant/Funding (self): Pfizer. All other authors have declared no conflicts of interest.