Esther N Pijnappel1, Willemieke P M Dijksterhuis1,2, Lydia G van der Geest2, Judith de Vos-Geelen3, Jan Willem B de Groot4, Marjolein Y V Homs5, Geert-Jan Creemers6, Nadia Haj Mohammad7, Marc G Besselink8, Hanneke W M van Laarhoven1, Johanna W Wilmink1. 1. Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam. 2. Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht. 3. Department of Internal Medicine, Division of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht. 4. Isala Oncology Center, Isala, Zwolle. 5. Department of Medical Oncology, Erasmus Medical Center. 6. Department of Medical Oncology, Catharina Hospital, Eindhoven. 7. Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht; and. 8. Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Abstract
BACKGROUND: Metastatic pancreatic ductal adenocarcinoma (PDAC) is characterized by a poor survival rate, which can be improved by systemic treatment. Consensus on the most optimal first- and second-line palliative systemic treatment is lacking. The aim of this study was to describe the use of first- and second-line systemic treatment, overall survival (OS), and time to failure (TTF) of first- and second-line treatment in metastatic PDAC in a real-world setting. PATIENTS AND METHODS: Patients with synchronous metastatic PDAC diagnosed between 2015 and 2018 who received systemic treatment were selected from the nationwide Netherlands Cancer Registry. OS and TTF were evaluated using Kaplan-Meier curves with log-rank test and multivariable Cox proportional hazard analyses. RESULTS: The majority of 1,586 included patients received FOLFIRINOX (65%), followed by gemcitabine (18%), and gemcitabine + nab-paclitaxel (13%) in the first line. Median OS for first-line FOLFIRINOX, gemcitabine + nab-paclitaxel, and gemcitabine monotherapy was 6.6, 4.7, and 2.9 months, respectively. Compared to FOLFIRINOX, gemcitabine + nab-paclitaxel showed significantly inferior OS after adjustment for confounders (hazard ratio [HR], 1.20; 95% CI, 1.02-1.41), and gemcitabine monotherapy was independently associated with a shorter OS and TTF (HR, 1.98; 95% CI, 1.71-2.30 and HR, 2.31; 95% CI, 1.88-2.83, respectively). Of the 121 patients who received second-line systemic treatment, 33% received gemcitabine + nab-paclitaxel, followed by gemcitabine (31%) and FOLFIRINOX (10%). CONCLUSIONS: Based on population-based data in patients with metastatic PDAC, treatment predominantly consists of FOLFIRINOX in the first line and gemcitabine with or without nab-paclitaxel in the second line. FOLFIRINOX in the first line shows superior OS compared with gemcitabine with or without nab-paclitaxel.
BACKGROUND: Metastatic pancreatic ductal adenocarcinoma (PDAC) is characterized by a poor survival rate, which can be improved by systemic treatment. Consensus on the most optimal first- and second-line palliative systemic treatment is lacking. The aim of this study was to describe the use of first- and second-line systemic treatment, overall survival (OS), and time to failure (TTF) of first- and second-line treatment in metastatic PDAC in a real-world setting. PATIENTS AND METHODS: Patients with synchronous metastatic PDAC diagnosed between 2015 and 2018 who received systemic treatment were selected from the nationwide Netherlands Cancer Registry. OS and TTF were evaluated using Kaplan-Meier curves with log-rank test and multivariable Cox proportional hazard analyses. RESULTS: The majority of 1,586 included patients received FOLFIRINOX (65%), followed by gemcitabine (18%), and gemcitabine + nab-paclitaxel (13%) in the first line. Median OS for first-line FOLFIRINOX, gemcitabine + nab-paclitaxel, and gemcitabine monotherapy was 6.6, 4.7, and 2.9 months, respectively. Compared to FOLFIRINOX, gemcitabine + nab-paclitaxel showed significantly inferior OS after adjustment for confounders (hazard ratio [HR], 1.20; 95% CI, 1.02-1.41), and gemcitabine monotherapy was independently associated with a shorter OS and TTF (HR, 1.98; 95% CI, 1.71-2.30 and HR, 2.31; 95% CI, 1.88-2.83, respectively). Of the 121 patients who received second-line systemic treatment, 33% received gemcitabine + nab-paclitaxel, followed by gemcitabine (31%) and FOLFIRINOX (10%). CONCLUSIONS: Based on population-based data in patients with metastatic PDAC, treatment predominantly consists of FOLFIRINOX in the first line and gemcitabine with or without nab-paclitaxel in the second line. FOLFIRINOX in the first line shows superior OS compared with gemcitabine with or without nab-paclitaxel.
Authors: Cliona M Lorton; Larissa Higgins; Niamh O'Donoghue; Claire Donohoe; Jim O'Connell; David Mockler; John V Reynolds; Declan Walsh; Joanne Lysaght Journal: Ann Surg Oncol Date: 2021-11-12 Impact factor: 5.344
Authors: Esther N Pijnappel; Willemieke P M Dijksterhuis; Mirjam A G Sprangers; Simone Augustinus; Judith de Vos-Geelen; Ignace H J T de Hingh; Izaak Q Molenaar; Olivier R Busch; Marc G Besselink; Johanna W Wilmink; Hanneke W M van Laarhoven Journal: Support Care Cancer Date: 2022-02-15 Impact factor: 3.359
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