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Real-world assessment of treatment sequencing of patients with advanced pancreatic cancer in a private practice in Rio de Janeiro, Brazil (Americas Oncologia RJ)
Background
The first-line treatment in advanced pancreatic cancer (ACP) is well established by phase III studies, with protocols FOLFIRINOX (FF) and gemcitabine/ nab-paclitaxel (GN). There are no phase III specifying optimal sequencing after disease progression to these first lines. The use of nabpaclitaxel was approved in Brazil for ACP treatment in 2017 and there is no approval for lipossomal irinotecan.
Methods
This retrospective cohort was held from the database of patients treated with chemotherapy for ACP in Americas Oncologia RJ, from June 2017 to January 2021. The primary endpoint was assessment of treatment sequencing and overall survival (OS).
Results
116 patients were analyzed with a median follow up of 10 months. At diagnosis the average age was 64.6 years, 52.6% were male and around 90% had performance status (PS) 2 - HR 0.30; CI 95% 0.17-0.54; p 2 lines, patients submitted to fewer lines had lower BMI (10.4% had BMI < 18.9 vs 5% ), younger age (62.5% vs 80% younger than 70 years) and worst PS (88% vs 95% PS 0-1). The most common treatment sequencings protocols were: 56% with fluorouracil protocols followed by gemcitabine combo (sequence 1), 28% with gemcitabine combo followed by protocols with fluorouracil (sequence 2) and 16% protocols with fluorouracil followed by gemcitabine alone (sequence 3). The median OS was significant inferior in sequence 3 (HR 4.24; 95% CI 1.52-11.8; p=0.006), with no differences between 1 and 2 sequences, regardless of age, BMI and OS in first line (HR 5.51; CI 95% 1.80-16.9; p = 0.0030). Fourteen pacientes were reexposed to previous lines, previously interrupted by disease progression. The median OS for them was 25 months. The most prescribed protocols were FF ( 70%) and GN (25%). The univariate analysis didn´t find significant predictive factors.
Conclusions
There were no statistical differences between sequencing flurorouracil combos with protocols with gemcitabine or GN followed by fluorouracil combos in pacientes treated in our service. The choice of each regimen should be individualized, taken into account mainly patient´s PS, age and BMI.
Legal entity responsible for the study
The authors.
Funding
Instituto COI.
Disclosures
All authors have declared no conflicts of interest.
