Treatment strategies and clinical outcomes in consecutive patients with locally advanced pancreatic cancer: A multicenter prospective cohort. (March 2021)

• Record Type: Journal Article
• Authors: Walma, Marieke S.; Brada, Lilly J.; Patuleia, Susana I.S.; Blomjous, Joost G.; Bollen, Thomas L.; Bosscha, Koop; Bruijnen, Rutger C.; Busch, Olivier R.; Creemers, Geert-Jan; Daams, Freek; van Dam, Ronald; Festen, Sebastiaan; Jan de Groot, Derk; Willem de Groot, Jan; Mohammad, Nadia Haj; Hermans, John J.; de Hingh, Ignace H.; Kerver, Emile D.; van Leeuwen, Maarten S.; van der Leij, Christiaan; Liem, Mike S.; van Lienden, Krijn P.; Los, Maartje; de Meijer, Vincent E.; Meijerink, Martijn R.; Mekenkamp, Leonie J.; Nederend, Joost; Nio, C. Yung; Patijn, Gijs A.; Polée, Marco B.; Pruijt, Johannes F.; Renken, Nomdo S.; Rombouts, Steffi J.; Schouten, Thijs J.; Stommel, Martijn W.J.; Verweij, Maaike E.; de Vos-Geelen, Judith; de Vries, Jan J.J.; Vulink, Annelie; Wessels, Frank J.; Wilmink, Johanna W.; van Santvoort, Hjalmar C.; Besselink, Marc G.; Molenaar, I. Quintus;
• Is Part Of: European journal of surgical oncology. Volume 47:Supplement Part B (2021)
• Page Start: 699
• Page End: 707
• Publication Date: 2021-03
• Subjects: Locally advanced pancreatic cancer -- FOLFIRINOX -- Treatment strategies; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.11.137
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: Since current studies on locally advanced pancreatic cancer (LAPC) mainly report from single, high-volume centers, it is unclear if outcomes can be translated to daily clinical practice. This study provides treatment strategies and clinical outcomes within a multicenter cohort of unselected patients with LAPC. Materials and methods: Consecutive patients with LAPC according to Dutch Pancreatic Cancer Group criteria, were prospectively included in 14 centers from April 2015 until December 2017. A centralized expert panel reviewed response according to RECIST v1.1 and potential surgical resectability. Primary outcome was median overall survival (mOS), stratified for primary treatment strategy. Results: Overall, 422 patients were included, of whom 77% ( n = 326) received chemotherapy. The majority started with FOLFIRINOX (77%, 252/326) with a median of six cycles (IQR 4–10). Gemcitabine monotherapy was given to 13% (41/326) of patients and nab-paclitaxel/gemcitabine to 10% (33/326), with a median of two (IQR 3–5) and three (IQR 3–5) cycles respectively. The mOS of the entire cohort was 10 months (95%CI 9–11). In patients treated with FOLFIRINOX, gemcitabine monotherapy, or nab-paclitaxel/gemcitabine, mOS was 14 (95%CI 13–15), 9 (95%CI 8–10), and 9 months (95%CI 8–10), respectively. A resection was performed in 13% (32/252) of patients after FOLFIRINOX, resulting in a mOS of 23 months (95%CI 12–34). Conclusion: This multicenter unselected cohort of patients with LAPC resulted in a 14 month mOS and a 13% resection rate after FOLFIRINOX. These data put previous results in perspective, enable us to inform patients with more accurate survival numbers and will support decision-making in clinical practice. Highlights: The majority of LAPC patients started anti-tumor treatment, mainly FOLFIRINOX (77%). mOS after FOLFIRINOX and (nab-paclitaxel/)gemcitabine was 14 and 9 months, respectively. There is no treatment paradigm after first-line treatment. A resection was performed in 13% of patients starting FOLFIRINOX, resulting in a mOS of 23 months. One out of 5 patients (22%) could undergo innovative therapies, mainly within clinical trials.