Anouk E J Latenstein1, Tara M Mackay1, Geert-Jan Creemers2, Casper H J van Eijck3, Jan Willem B de Groot4, Nadia Haj Mohammad5, Marjolein Y V Homs6, Hanneke W M van Laarhoven7, I Quintus Molenaar8, Bert-Jan Ten Tije9, Judith de Vos-Geelen10, Marc G Besselink1, Lydia G M van der Geest11, Johanna W Wilmink7. 1. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. 2. Department of Oncology, Catharina Hospital, Eindhoven, The Netherlands. 3. Department of Surgery, Erasmus MC, Rotterdam, The Netherlands. 4. Department of Medical Oncology, Oncology Center Isala, Zwolle, The Netherlands. 5. Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 6. Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands. 7. Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. 8. Department of Surgery, Regional Academic Cancer Center Utrecht, St Antonius Hospital Nieuwegein and University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands. 9. Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands. 10. Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands. 11. Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
Abstract
Background: Positive results of randomized trials led to the introduction of FOLFIRINOX in 2012 and gemcitabine with nab-paclitaxel in 2015 for patients with metastatic pancreatic ductal adenocarcinoma. It is unknown to which extent these new chemotherapeutic regimens have been implemented in clinical practice and what the impact has been on overall survival.Material and methods: Patients diagnosed with metastatic pancreatic ductal adenocarcinoma between 2007-2016 were included from the population-based Netherlands Cancer Registry. Multilevel logistic regression and Cox regression analyses, adjusting for patient, tumor, and hospital characteristics, were used to analyze variation of chemotherapy use. Results: In total, 8726 patients were included. The use of chemotherapy increased from 31% in 2007-2011 to 37% in 2012-2016 (p < .001). Variation in the use of any chemotherapy between centers decreased (adjusted range 2007-2011: 12-67%, 2012-2016: 20-54%) whereas overall survival increased from 5.6 months to 6.4 months (p < .001) for patients treated with chemotherapy. Use of FOLFIRINOX and gemcitabine with nab-paclitaxel varied widely in 2015-2016, but both showed a more favorable overall survival compared to gemcitabine monotherapy (median 8.0 vs. 7.0 vs. 3.8 months, respectively). In the period 2015-2016, FOLFIRINOX was used in 60%, gemcitabine with nab-paclitaxel in 9.7% and gemcitabine monotherapy in 25% of patients receiving chemotherapy. Conclusion: Nationwide variation in the use of chemotherapy decreased after the implementation of FOLFIRINOX and gemcitabine with nab-paclitaxel. Still a considerable proportion of patients receives gemcitabine monotherapy. Overall survival did improve, but not clinically relevant. These results emphasize the need for a structured implementation of new chemotherapeutic regimens.
Background: Positive results of randomized trials led to the introduction of FOLFIRINOX in 2012 and gemcitabine with nab-paclitaxel in 2015 for patients with metastatic pancreatic ductal adenocarcinoma. It is unknown to which extent these new chemotherapeutic regimens have been implemented in clinical practice and what the impact has been on overall survival.Material and methods: Patients diagnosed with metastatic pancreatic ductal adenocarcinoma between 2007-2016 were included from the population-based Netherlands Cancer Registry. Multilevel logistic regression and Cox regression analyses, adjusting for patient, tumor, and hospital characteristics, were used to analyze variation of chemotherapy use. Results: In total, 8726 patients were included. The use of chemotherapy increased from 31% in 2007-2011 to 37% in 2012-2016 (p < .001). Variation in the use of any chemotherapy between centers decreased (adjusted range 2007-2011: 12-67%, 2012-2016: 20-54%) whereas overall survival increased from 5.6 months to 6.4 months (p < .001) for patients treated with chemotherapy. Use of FOLFIRINOX and gemcitabine with nab-paclitaxel varied widely in 2015-2016, but both showed a more favorable overall survival compared to gemcitabine monotherapy (median 8.0 vs. 7.0 vs. 3.8 months, respectively). In the period 2015-2016, FOLFIRINOX was used in 60%, gemcitabine with nab-paclitaxel in 9.7% and gemcitabine monotherapy in 25% of patients receiving chemotherapy. Conclusion: Nationwide variation in the use of chemotherapy decreased after the implementation of FOLFIRINOX and gemcitabine with nab-paclitaxel. Still a considerable proportion of patients receives gemcitabine monotherapy. Overall survival did improve, but not clinically relevant. These results emphasize the need for a structured implementation of new chemotherapeutic regimens.
Authors: Fleur van der Sijde; Jacob L van Dam; Bas Groot Koerkamp; Brigitte C M Haberkorn; Marjolein Y V Homs; Daniëlle Mathijssen; Marc G Besselink; Johanna W Wilmink; Casper H J van Eijck Journal: J Oncol Date: 2022-07-07 Impact factor: 4.501
Authors: Citadel J Cabasag; Melina Arnold; Mark Rutherford; Aude Bardot; Jacques Ferlay; Eileen Morgan; Alana Little; Prithwish De; Elijah Dixon; Ryan R Woods; Nathalie Saint-Jacques; Sue Evans; Gerda Engholm; Mark Elwood; Neil Merrett; David Ransom; Dianne L O'Connell; Freddie Bray; Isabelle Soerjomataram Journal: Br J Cancer Date: 2022-03-02 Impact factor: 9.075
Authors: Esther N Pijnappel; Melinda Schuurman; Anna D Wagner; Judith de Vos-Geelen; Lydia G M van der Geest; Jan-Willem B de Groot; Bas Groot Koerkamp; Ignace H J T de Hingh; Marjolein Y V Homs; Geert-Jan Creemers; Geert A Cirkel; Hjalmar C van Santvoort; Olivier R Busch; Marc G Besselink; Casper H J van Eijck; Johanna W Wilmink; Hanneke W M van Laarhoven Journal: Front Oncol Date: 2022-03-24 Impact factor: 6.244