Cytotoxic Chemotherapy for Pancreatic Adenocarcinoma in England 2010-2017: Survival Outcomes

Cytotoxic chemotherapy is widely used in the management of pancreatic adenocarcinoma as adjuvant treatment after radical surgery and also in advanced disease. The results of randomised trials in selected patient groups provide reliable evidence of comparative treatment efficacy, but studies of population-based observational cohorts provide insight into survival outcomes in routine care.

We conducted a large population-based observational cohort study of patients, diagnosed during 2010-2017, who received chemotherapy within the National Health Service in England. We considered overall survival and 30-day all-cause mortality risk after chemotherapy. We conducted a literature search to compare these results to published studies.

In total, 9390 patients were included in the cohort. For 1114 patients treated with radical surgery and chemotherapy with curative intent, overall survival from the start of chemotherapy was 75.8% (95% confidence interval 73.3-78.3) at 1 year and 22.0% (18.6-25.3) at 5 years. For 7468 patients treated with non-curative intent, overall survival was 29.6% (28.6-30.6) at 1 year and 2.0% (1.6-2.4) at 5 years. In both groups, poorer performance status at the start of chemotherapy was strongly associated with poorer survival. The risk of 30-day mortality in patients treated with non-curative intent was 13.6% (12.8-14.5). This was higher in younger patients and those with higher stage disease and a poorer performance status.

Survival in this general population was poorer than that published in randomised trials. This study will aid informed discussion with patients regarding anticipated outcomes in routine clinical care.