Real World Evidence of Clinical Outcomes of First-Line Chemotherapy in Locally Advanced and Metastatic Pancreatic Adenocarcinoma Patients

Abstract

PURPOSE: Pancreatic cancer has poor prognosis, with a five-year survival rate of approximately 10%. This study evaluated the clinical outcomes of first-line chemotherapy (CMT) for patients with locally advanced and metastatic pancreatic ductal adenocarcinoma (LA/M-PDAC). PATIENTS AND METHODS: A retrospective chart review was conducted of patients with LA/M-PDAC who underwent CMT between January 2008 and December 2018. 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-squared tests, Kaplan-Meier plots, and log-rank tests. RESULTS: Of 998 patients diagnosed with LA/M-PDAC, 332 (33.3%) underwent systemic CMT. Among the treatment regimens used, gemcitabine (GEM) was most commonly administered (33.7%). The next most common therapies were (m)FOLFIRINOX and GEM plus capecitabine (GEMCAPE), accounting for 27.4% and 26.2% of cases, respectively. The ORRs were 4.5, 10.3, 23.1, and 19.4% for GEM, GEMCAPE, (m)FOLFIRINOX, and Platinum doublets (PlatD), respectively. Patients who received combination CMTs had significantly longer median PFS than those who received GEM alone (PFS = 4.93 months (mos) for GEMCAPE, 9 mos for (m)FOLFIRINOX, 9.43 mos for PlatD, and 3.87 mos for GEM). However, no significant differences were observed in the median OS rates among the four regimens. The treatment-related grade 3 or 4 adverse events were highest in the (m)FOLFIRINOX group. CONCLUSION: In the first-line treatment of PDAC, (m)FOLFIRINOX exhibited higher ORR and PFS than GEM or GEMCAPE. However, no survival advantage was observed in the (m)FOLFIRINOX group, suggesting an influence of subsequent therapy.