Outcomes for patients diagnosed with metastatic pancreatic ductal adenocarcinoma (mPDAC): a tertiary referral centre experience.


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Angela Lamarca1,Robert D Morgan1,Christina Rigby1,Rille Pihlak2,Lynne McCallum1,Mairéad G McNamara2,Juan W Valle2,Richard A Hubner1
1Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom,2Department of Medical Oncology, The Christie NHS Foundation Trust; Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, United Kingdom

Abstract

Background

Prognosis in mPDAC may be influenced by patient and treatment factors; outcomes were assessed in these patients referred to a specialist oncology centre.

Method

All consecutive patients with mPDAC (Jan’12-Dec’15) were included. The primary end-point was overall survival (OS), defined as time from starting first-line chemotherapy (for patients receiving chemotherapy) or from first Medical Oncology appointment (for those receiving best supportive care (BSC)), to date of death (or date last seen for patients alive at data cut-off date). Kaplan-Meier and uni/multivariable Cox-regression were employed for survival analyses.

Results

In total, 374 patients were included. Median age was 68 years and 53% were male. Baseline performance status (PS) was 0-1 in 54%; 2 in 27% and ≥3 in 19%. At the end of follow-up, 94% of patients had died. Among 207 (55%) patients who received chemotherapy (PS 0-1 (76%), 2 (23%) and 3 (1%)), the median OS was 4.9 months (95% confidence interval (CI): 4.4-6.1). Chemotherapy regimens included gemcitabine (51% of treated patients; median OS 4.2 months, 95% CI: 3.5-4.7), gemcitabine/capecitabine (23%; 6.6 months, 95% CI: 4.5-9.6), gemcitabine/nab-paclitaxel (12%; 5.4 months, 95% CI: 3.4-7.7), FOLFIRINOX (9%; 10.7 months, 95% CI: 7.5-14.1) or others (5%). Median OS was longer with combination chemotherapy (7.4 months, 95% CI: 5.9-9.2) compared to monotherapy (4.2 months, 95% CI: 3.6-4.7), p<0.001. The median OS was 1.3 months (95% CI: 1.1-1.7) in 167 (45%) patients who had BSC (presented primarily with PS 2 (32%) or 3 (42%)). Multivariable analysis identified PS<3 (p<0.001) and combination chemotherapy (p0.002) as independent favourable prognostic factors in chemotherapy-treated patients. Only 21 (10%) patients who received chemotherapy received second-line chemotherapy; two patients received third-line treatment.

Conclusion

Improving outcomes for patients with mPDAC remains challenging with approximately half of patients receiving first-line chemotherapy and few receiving second-line treatment. Combination chemotherapy improves outcomes compared to monotherapy or BSC.