666 Background: Pancreatic cancer is the third deadliest cancer in the US and mPC has a 2.9% 5-year survival. The analyses herein describe treatment patterns, trends in usage, and overall survival (OS) in mPC. Methods: Using the Flatiron Health EHR-derived database, data were extracted and analyzed for patients with mPC (pts) between Jan 1, 2014 and Jun 30, 2019. The database includes de-identified data from over 280 cancer clinics (~800 sites of care) representing more than 2.2 million U.S. cancer patients available for analysis, with 80% of pts from community centers and 20% from academic centers. Lines of therapy in the metastatic setting are derived from structured medication records. OS from metastatic diagnosis was reported using the Kaplan-Meier method. Results: 7,666 pts with mPC were identified. 5,687 (74.2%) received therapy in the metastatic setting. Pts who didn’t receive therapy in the metastatic setting were more likely to be older (p < 0.0001) and less likely to have been diagnosed initially with stage IV disease (p < 0.0001) than pts who were treated. The frequency of (1L) regimens were gemcitabine plus nab-paclitaxel (GnP) 46.8%, FOLFIRINOX (FFX) 24.1%, gemcitabine monotherapy 9.3%, and FOLFOX 3.8%. Gemcitabine monotherapy use was 12.9% in 2014 and 7.3% in 2018. GnP (31.4%), FFX (12.3%), FOLFOX (11.4%), and liposomal irinotecan (nal-IRI) + 5-FU/LV (10.2%) were the most frequent second line (2L) regimens. Between 2015 and 2018 nal-IRI based regimens increased from 6% to 17.6% in 2L. In the third line (3L) setting nal-IRI + 5FU/LV (19.3%), GnP (12.1%), FOLFOX (11.4%), and FFX (9.1%) were the most common treatments. Aggregate median OS (mOS) for treated pts was 8.1 mos (95% CI 7.8 – 8.4), and mOS for untreated pts was 2.8 mos (2.6 – 3.0), p < 0.0001. Conclusions: Survival for mPC is improving and practice patterns are changing. GnP is the most commonly used 1L regimen, followed increasingly by nal-IRI + 5-FU/LV in 2L and 3L. Further studies are necessary to understand the treatment gaps for pts with mPC. [Table: see text]
The aim of this study was to evaluate the value index of tumor biomarkers for diagnosis and prediction of bone metastasis by combining pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP) in serum with other biochemical markers in patients with several cancers. All of 1253 patients and biomarkers data with cancers and the related benign diseases and 312 healthy controls were included in the study. Bioinformatics, data mining technology and statistics were carried out to calculate sum of direct positive index (SDPI) and sum of indirect positive index (SIPI). The average ICTP was higher in patients with bone metastasis from liver, gastric, lung, colorectal and pancreatic cancer, than in cancer patients without bone metastasis. For those cancers patients with bone metastasis, which could not be differentiated by single ICTP, combining with SDPI and SIPI would distinguish types of carcinama in situ from similar symptoms. The measurement of multiple tumor markers was very useful in complementary diagnosis and prediction of different carcinoma with bone metastasis bottom.
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