Impact of New Chemotherapy Regimens on the Treatment Landscape and Survival of Locally Advanced and Metastatic Pancreatic Cancer Patients

Abstract

Background: New chemotherapy regimens for the treatment of metastatic pancreatic cancer have changed the therapy paradigm. We aimed to assess their impact on the treatment landscape and clinical outcome at our academic institution. Methods: In this single institutional posthoc registry analysis, we assessed characteristics and survival rates from all patients with locally advanced and metastatic pancreatic cancer who started a systemic treatment between 01/2011 and 12/2017. Survival analyses were performed by Kaplan-Meier and Cox proportional hazards model. Results: A total of 301 patients started a systemic treatment in the observation period. In the first line treatment, we observed a shift from the four different main regimens (gemcitabine/nab-paclitaxel, modified FOLFIRINOX, gemcitabine/oxaliplatin +/− erlotinib or gemcitabine alone) to gemcitabine/nab-paclitaxel and modified FOLFIRINOX that add up to more than 80% of administered first line treatments in each of the time cohorts (2011–2013 vs. 2014–2017). The rate for first line modified FOLFIRINOX treatment was balanced between the two groups (19% and 15%). Median overall survival differed significantly between the two time cohorts (8.89 versus 11.9 months, p = 0.035). Survival rates for different first to second line treatment sequences (modified FOLFIRINOX to gemcitabine/nab-paclitaxel, gemcitabine/nab-paclitaxel to fluoropyrimidines plus nanoliposomal irinotecan, or gemcitabine/nab-paclitaxel to fluoropyrimidines plus oxaliplatin) were not significantly different and median overall survival ranged from 14.27 to 15.64 months. Conclusion: Our study provides real-world evidence for the effectiveness of the new chemotherapy regimens and underscores the importance of the choice of the front-line regimen when considering different sequencing strategies.

Liposomal Irinotecan: A Review in Metastatic Pancreatic Adenocarcinoma

“…2.2 ); this approximates the median OS seen in early-stage pancreatic patients managed with Whipple resection (≈ 16 months [ 49 ]). In Europe, Austrian investigators have attributed the improvement in survival benefit observed at their institution over time to changes in treatment patterns, in particular to the introduction of sequential therapy with first-line gemcitabine + nab-paclitaxel followed by second-line nal-IRI + 5-FU/LV [ 50 ]. Elsewhere in Europe, the efficacy of second-line nal-IRI + 5-FU/LV in patients with advanced PDAC following the failure of first-line gemcitabine + nab-paclitaxel is currently being evaluated as part of a phase III trial being conducted in Germany (PREDICT; NCT03468335).…”

Inhibition of PI3K/AKT signaling via ROS regulation is involved in Rhein-induced apoptosis and enhancement of oxaliplatin sensitivity in pancreatic cancer cells

“…Because of a lack of symptoms, patients are often diagnosed with PC at an advanced stage. Only a few patients have an opportunity for surgical resection, which makes chemotherapy an important component in the systemic treatment of PC [3,4].…”

Reduced and Normalized Carbohydrate Antigen 19-9 Concentrations after Neoadjuvant Chemotherapy Have Comparable Prognostic Performance in Patients with Borderline Resectable and Locally Advanced Pancreatic Cancer

“…Radical surgery, including vascular reconstruction, has been reported as technically feasible, expanding surgical indications for PDAC [2]. Moreover, recent studies showed that patients with borderline resectable (BRPC) or locally advanced pancreatic cancer (LAPC) who underwent surgery after neoadjuvant chemotherapy (NACT) had better survival outcomes than those who underwent upfront surgery [3][4][5][6].…”