A Abendroth1,2, R Noureddine1, M Abramczyk1, A Paul3,4,2, G Gerken5,2, K W Schmid6,4,2, P Markus7,2, B Schumacher8, M Wiesweg1,2, J Köhler1,2, M Markus1, B Mende9, A Dechêne5,2, M Schuler1,4,2, S Kasper10,11. 1. Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany. 2. Medical Faculty, University Duisburg-Essen, Essen, Germany. 3. Department of General, Visceral and Transplant Surgery, West German Cancer Center, University Hospital Essen, Essen, Germany. 4. German Cancer Consortium (DKTK), Partner site University Hospital Essen, Essen, Germany. 5. Department of Gastroenterology and Hepatology, West German Cancer Center, University Hospital Essen, Essen, Germany. 6. West German Cancer Center, Institute of Pathology Essen, University Hospital Essen, Essen, Germany. 7. Department of General Surgery and Traumatology, Elisabeth Hospital Essen, Essen, Germany. 8. Department of Gastroenterology, Elisabeth Hospital Essen, Essen, Germany. 9. Central Pharmacy, University Hospital Essen, Essen, Germany. 10. Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany. Stefan.Kasper@uk-essen.de. 11. Medical Faculty, University Duisburg-Essen, Essen, Germany. Stefan.Kasper@uk-essen.de.
Abstract
INTRODUCTION: Patients (pts) with locally advanced (LAPC) or metastatic pancreatic ductal adenocarcinoma (mPDAC) have a dismal prognosis. Recently, new combination chemotherapies such as FOLFIRINOX and nab-paclitaxel/gemcitabine have demonstrated superiority over gemcitabine monotherapy. However, a substantial proportion of pts cannot tolerate these intensive front-line protocols. Moreover, the long-term superiority of multiagent protocols over less intensive strategies remains to be shown. To provide a benchmark for future studies, we analyzed the outcome of patients with LAPC or mPDAC treated at the West German Cancer Center before the FOLFIRINOX/nab-paclitaxel + gemcitabine era. METHODS: This retrospective analysis included 201 consecutive pts with LAPC and mPDAC treated between 2007 and 2011. Efficacy parameters were correlated with type of chemotherapy, number of treatment lines and clinicopathological parameters. RESULTS: Gemcitabine monotherapy was given as first-line therapy in 51.1%, whereas 48.9% received combination chemotherapies such as gemcitabine/oxaliplatin or FOLFOX. Patients received a median of two lines of treatment, with 54.8% receiving second-line and 37.9% receiving third- and further-line therapies. There was no significant difference between gemcitabine monotherapy and combination therapies. Despite moderate activity of first-line treatment, median overall survival for LAPC was 11.3 months and 8.7 months for mPDAC. Multivariate analysis identified age and number of treatment lines as prognostic markers. CONCLUSION: The long-term outcome of unselected pts with LAPC and mPDAC treated before the introduction of aggressive multiagent chemotherapy protocols compares favorably with the results of contemporary benchmark trials. This suggests a multifactorial benefit from interdisciplinary care provided over sequential treatment lines at high volume expert centers.
INTRODUCTION:Patients (pts) with locally advanced (LAPC) or metastatic pancreatic ductal adenocarcinoma (mPDAC) have a dismal prognosis. Recently, new combination chemotherapies such as FOLFIRINOX and nab-paclitaxel/gemcitabine have demonstrated superiority over gemcitabine monotherapy. However, a substantial proportion of pts cannot tolerate these intensive front-line protocols. Moreover, the long-term superiority of multiagent protocols over less intensive strategies remains to be shown. To provide a benchmark for future studies, we analyzed the outcome of patients with LAPC or mPDAC treated at the West German Cancer Center before the FOLFIRINOX/nab-paclitaxel + gemcitabine era. METHODS: This retrospective analysis included 201 consecutive pts with LAPC and mPDAC treated between 2007 and 2011. Efficacy parameters were correlated with type of chemotherapy, number of treatment lines and clinicopathological parameters. RESULTS:Gemcitabine monotherapy was given as first-line therapy in 51.1%, whereas 48.9% received combination chemotherapies such as gemcitabine/oxaliplatin or FOLFOX. Patients received a median of two lines of treatment, with 54.8% receiving second-line and 37.9% receiving third- and further-line therapies. There was no significant difference between gemcitabine monotherapy and combination therapies. Despite moderate activity of first-line treatment, median overall survival for LAPC was 11.3 months and 8.7 months for mPDAC. Multivariate analysis identified age and number of treatment lines as prognostic markers. CONCLUSION: The long-term outcome of unselected pts with LAPC and mPDAC treated before the introduction of aggressive multiagent chemotherapy protocols compares favorably with the results of contemporary benchmark trials. This suggests a multifactorial benefit from interdisciplinary care provided over sequential treatment lines at high volume expert centers.
Authors: Matthew B Lipner; Xianlu L Peng; Chong Jin; Yi Xu; Yanzhe Gao; Michael P East; Naim U Rashid; Richard A Moffitt; Silvia G Herrera Loeza; Ashley B Morrison; Brian T Golitz; Cyrus Vaziri; Lee M Graves; Gary L Johnson; Jen Jen Yeh Journal: JCI Insight Date: 2020-04-23
Authors: M Markus; A Abendroth; R Noureddine; A Paul; S Breitenbuecher; I Virchow; K W Schmid; P Markus; B Schumacher; M Wiesweg; J Wendling; B Mende; J T Siveke; M Schuler; S Kasper Journal: J Cancer Res Clin Oncol Date: 2020-08-25 Impact factor: 4.553