A real world multicenter study of first (1L) and second (2L) line treatment patterns and outcomes in advanced pancreatic cancer (APC).

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 476-476 ◽  
Author(s):  
Winson Y. Cheung ◽  
Hanbo Zhang ◽  
Patricia A. Tang ◽  
Jennifer L. Spratlin ◽  
Richard M. Lee-Ying ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Real World ◽  
Treatment Options ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Tumor Location ◽  
Treatment Patterns ◽  
Treatment Selection ◽  
Multi Agent ◽  
Practice Methods

476 Background: FOLFIRINOX (FFX), gemcitabine plus nab-paclitaxel (GN), and gemcitabine (gem) are 3 publicly funded and available treatment options for locally advanced (LAPC) and metastatic pancreatic cancer (MPC) in Canada since 2014. Without head-to-head trials that directly compare all 3 regimens, treatment selection and outcomes in 1L and 2L remain poorly characterized in routine clinical practice. Methods: Data from 4 tertiary, 8 regional, and 28 community hospitals in Canada were pooled. LAPC and MPC patients diagnosed from 2014 onwards and who received at least 1 line of systemic therapy were included. Analyses were conducted to identify predictors of treatment choice and to determine the relationship between treatment patterns and overall survival (OS) from APC diagnosis to death. Results: We identified 279 eligible patients. Median age was 64 (IQR 56-69) years, 55% were men, and 46% were ECOG ≥2. There were 27% LAPC and 73% MPC. In the 1L setting, FFX and GN were given in 44% and 41% of patients, respectively, and gem in 15%. GN was the preferred multi-agent therapy in worse ECOG patients (66% in ECOG 2+ vs 21% in ECOG 0, p = .001) and in more recently diagnosed cases (63% in 2016 vs 25% in 2014, p = .001). 1L treatment selection was not influenced by other baseline characteristics, such as age, sex, tumor location, or LAPC vs MPC status (all p > 0.05). A total of 91 patients proceeded to subsequent therapies, of whom 55 (60%), 27 (30%), and 9 (10%) had received 1L FFX, GN, and gem, respectively. In the 2L setting, GN after 1L FFX (41/55; 75%) and fluoropyrimidine (FP) after 1L GN (21/27; 78%) were the most common sequential approaches. Patients who underwent 2L therapy had better OS than those who did not (13 vs 7 months, p = .001). After adjusting for confounders, receipt of 1L FFX plus 2L GN or 1L GN plus 2L FP resulted in improved OS when compared to other treatment sequences (HR 0.43, 95%CI 0.28-0.67, p = 0.001 and HR 0.57, 95%CI 0.39-0.83, p = 0.004, respectively). Conclusions: One third of APC patients receive 2L therapy, highlighting the feasibility of 2L trials. Use of 1L multi-agent therapy followed by 2L non-cross-resistant regimens represents a reasonable treatment strategy for APC in the real world.

scholarly journals Local Ablative Strategies for Ductal Pancreatic Cancer (Radiofrequency Ablation, Irreversible Electroporation): A Review

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Salvatore Paiella ◽  
Roberto Salvia ◽  
Marco Ramera ◽  
Roberto Girelli ◽  
Isabella Frigerio ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiofrequency Ablation ◽  
Therapeutic Option ◽  
Treatment Options ◽  
Locally Advanced ◽  
Irreversible Electroporation ◽  
Advanced Pancreatic Cancer ◽  
Ductal Adenocarcinoma ◽  
Dismal Prognosis ◽  
Ablative Techniques

Pancreatic ductal adenocarcinoma (PDAC) has still a dismal prognosis. Locally advanced pancreatic cancer (LAPC) accounts for the 40% of the new diagnoses. Current treatment options are based on chemo- and radiotherapy regimens. Local ablative techniques seem to be the future therapeutic option for stage-III patients with PDAC. Radiofrequency Ablation (RFA) and Irreversible Electroporation (IRE) are actually the most emerging local ablative techniques used on LAPC. Initial clinical studies on the use of these techniques have already demonstrated encouraging results in terms of safety and feasibility. Unfortunately, few studies on their efficacy are currently available. Even though some reports on the overall survival are encouraging, randomized studies are still required to corroborate these findings. This study provides an up-to-date overview and a thematic summary of the current available evidence on the application of RFA and IRE on PDAC, together with a comparison of the two procedures.

scholarly journals Conversion Therapy of Unresectable Pancreatic Cancer: A Retrospective Study of the Real World

2021 ◽  
Author(s):  
Mingxing Wang ◽  
Pengfei Zhu ◽  
Zheling Chen ◽  
Liu Yang
Keyword(s):  
Pancreatic Cancer ◽  
Retrospective Study ◽  
Real World ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Progression Free Survival ◽  
Unresectable Pancreatic Cancer ◽  
Conversion Therapy ◽  
The Real ◽  
Zhejiang Provincial

Abstract Objective: A retrospective study of the real world was conducted to analyze whether patients with unresectable pancreatic cancer (URPC) can benefit from conversion therapy, and to screen out pancreatic cancer patients who are suitable for conversion therapy.Patients and Methods: Inquired about patients with URPC who visited Zhejiang Provincial People's Hospital from January 2015 to April 2021. We selected 25 patients with URPC who underwent conversion therapy, and 19 patients with locally advanced pancreatic cancer (LAPC) who directly underwent surgery to conducted a retrospective analysis. Results: The median overall survival (OS) of 25 patients with URPC who received conversion therapy was 28 months (95%CI: 15.46-40.54 months), and the median progression-free survival (PFS) was 12 months (95%CI: 9.26-14.74 months). The curative resection (R0) rate was 84% (22/25).Conclusions: Conversion therapy improves the R0 rate of patients with URPC, and prolongs OS and PFS.

Head-to-head comparison of first-line FOLFIRINOX versus gemcitabine plus nabpaclitaxel (GN) in advanced pancreatic cancer (APC): A target trial emulation using Canadian real-world data.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18713-e18713
Author(s):  
Devon J. Boyne ◽  
Darren Brenner ◽  
Alind Gupta ◽  
Eric Mackay ◽  
Paul Arora ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Median Survival ◽  
Real World ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Medical Decision ◽  
Target Trial ◽  
Real World Data ◽  
World Data

e18713 Background: When randomized trials are not available, observational real-world data can be used to emulate a (hypothetical) target trial. The procedure starts with the specification of the protocol of the target trial, whose components are then explicitly emulated using observational data. This approach prevents biases that are common when using more conventional methods for real-world data. Advanced pancreatic cancer represents an opportunity for trial emulation since two main frontline therapies, FOLFIRINOX and GN, have never been directly compared in a randomized fashion. The choice between the two regimens is largely based on physician discretion and patient preference rather than direct comparison of effectiveness. Methods: We emulated a target trial using linked data from the provincial cancer registry, electronic health records and various administrative databases from Alberta, Canada. Eligible individuals had locally advanced or metastatic pancreatic cancer diagnosed between Jan. 2015- Dec. 2018, no prior treatment, and adequate hematologic and serum creatinine values. They were followed from diagnosis until March 2020, death, or date of last known contact with the healthcare system. We estimated the effect of initiating FOLFIRINOX vs. GN within 8 weeks of diagnosis on overall survival. Cloning, artificial censoring, and inverse probability weighting were used to address unknown treatment assignment at baseline, non-adherence, and confounding. Adjusted Kaplan-Meier survival curves and hazard ratios were estimated. Results: Of 298 eligible individuals, 70 adhered to the FOLFIRINOX strategy and 147 to the GN strategy. The mean age was 65 years, 173 (58%) were male, and 247 (83%) had metastatic disease. The adjusted median survival, 1-year survival, and 2-year survival for FOLFIRNOX was 8.2 months (95% CI: 5.3 to 9.4), 36.9% (22.2 to 55.8), and 14.1% (4.8 to 32.2), respectively; and for GN was 4.8 months (3.3 to 5.3), 22.2% (13.6 to 35.9), and 4.7% (1.7 to 13.0), respectively. The adjusted difference in median survival was 3.4 months (0.6 to 11.1) and the adjusted hazard ratio was 0.79 (0.56 to 1.05). Conclusions: Target trial emulations can help to inform medical decision making in situations where head-to-head randomized trial data are unavailable or unfeasible. Findings from this real-world trial emulation suggest improved overall survival with FOLFIRINOX over GN.

Immunotherapy in pancreatic cancer and the importance of tumour testing

2020 ◽  
Vol 13 (7) ◽  
pp. e235774
Author(s):  
Phuong Ngo ◽  
Mohamed Shanshal ◽  
Adam Rojan
Keyword(s):  
Pancreatic Cancer ◽  
Genetic Testing ◽  
Adjuvant Chemotherapy ◽  
Mismatch Repair ◽  
Poor Prognosis ◽  
Treatment Options ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Additional Treatment ◽  
Clinical Suspicion

Advanced pancreatic cancer carries a poor prognosis and has traditionally been treated with chemotherapy. However, immunotherapy has made great strides in a subset of patients depending on mismatch repair/microsatellite status. We present a patient with locally advanced pancreatic cancer treated with neoadjuvant chemotherapy followed by surgery and additional adjuvant chemotherapy whose disease progressed while on adjuvant chemotherapy. Tumour testing showed a mismatch repair mutation and high microsatellite instability, making her eligible for treatment with immunotherapy. Germline genetic testing confirmed the clinical suspicion of Lynch syndrome. She has had isolated sites of progression treated with radiation but overall has been receiving immunotherapy for more than 3 years, highlighting the importance of tumour testing as it may allow for additional treatment options and improved survival.

scholarly journals Higher overall survival in metastatic pancreatic cancer: the impact of where and how treatment is delivered

2015 ◽  
Vol 13 (3) ◽  
pp. 347-351 ◽  
Author(s):  
Pedro Luiz Serrano Usón Junior ◽  
Monique Sedlmaier França ◽  
Heloisa Veasey Rodrigues ◽  
Antônio Luiz de Vasconcellos Macedo ◽  
Alberto Goldenberg ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Median Survival ◽  
Metastatic Cancer ◽  
Treatment Options ◽  
Advanced Pancreatic Cancer ◽  
Stage Iv ◽  
Tumor Location ◽  
Access To Treatment ◽  
The Impact

Objective To determine the overall survival of patients with advanced pancreatic cancer and evaluate factors that impact prognosis in a private cancer center.Methods Data from the Hospital Cancer Registry at Hospital Israelita Albert Einstein were retrospectively collected. The patients enrolled had metastatic cancer at diagnosis or earlier staging and subsequent recurrence. Cases of neuroendocrine tumors were excluded.Results A total of 65 patients were evaluated, including 63 with adenocarcinoma. The median overall survival for patients in all stages was 20.7 months (95%CI: 15.6-25.7), while the overall survival of metastatic disease was 13.3 months. Among the 33 cases with stage IV cancer, there was no evidence of a statistically significant association between median survival and CA19-9 dosage (p=0.212), tumor location (p=0.482), first treatment performed (p=0.337), lymphovascular invasion (p=0.286), and age (p=0.152). However, the number of lines of chemotherapy was significantly associated with survival (log-rank p=0.013), with an estimated median survival of 10.2 months for patients who received up to two lines of treatment and 23.5 months for those receiving more than two lines of chemotherapy.Conclusion The survival of patients treated was longer than that reported in the literature. The only statistically significant factor related to increased survival was higher number of lines of chemotherapy received. We believe that the higher socioeconomic status of patients surveyed in this study, as well as their greater access to treatment options, may have influenced their overall survival.

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