Treatment strategies and clinical outcomes in consecutive patients with locally advanced pancreatic cancer: A multicenter prospective cohort

Eur J Surg Oncol. 2021 Mar;47(3 Pt B):699-707. doi: 10.1016/j.ejso.2020.11.137. Epub 2020 Nov 26.

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.

Keywords: FOLFIRINOX; Locally advanced pancreatic cancer; Treatment strategies.

Publication types

  • Multicenter Study

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / therapy*
  • Aged
  • Albumins / administration & dosage
  • Antimetabolites, Antineoplastic / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cohort Studies
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives
  • Deoxycytidine / therapeutic use
  • Female
  • Fluorouracil / therapeutic use
  • Humans
  • Irinotecan / therapeutic use
  • Leucovorin / therapeutic use
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Oxaliplatin / therapeutic use
  • Paclitaxel / administration & dosage
  • Pancreatectomy*
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / therapy*
  • Prospective Studies
  • Response Evaluation Criteria in Solid Tumors
  • Survival Rate

Substances

  • 130-nm albumin-bound paclitaxel
  • Albumins
  • Antimetabolites, Antineoplastic
  • folfirinox
  • Oxaliplatin
  • Deoxycytidine
  • Irinotecan
  • gemcitabine
  • Paclitaxel
  • Leucovorin
  • Fluorouracil