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Published on: February 2, 2024
Metastatic pancreatic adenocarcinoma: Real-world efficacy of first line treatment
Mélanie Debiais1, Anthony Tarabay1, Sarah Blanchet-Deverly1
1Gustave Roussy, Département de Médecine Oncologique, Villejuif 94805, France.
Background:
Metastatic pancreatic adenocarcinoma (mPDAC) has a poor prognosis. FOLFIRINOX (FFX) and gemcitabine nab-paclitaxel (GN) are the preferred first line (L1) regimens. We evaluated real-world outcomes of L1 therapies.
Methods:
Retrospective analysis of all patients who received L1 chemotherapy for mPDAC between 2010 and 2024 at a single academic comprehensive cancer center.
Results:
A total of 1012 patients were included: 48 % women, median age 63 years, 91 % ECOG 0-1. Synchronous metastases occurred in 66 % of patients. Liver (67 %), lung (20 %) and peritoneum (20 %) were the most frequent sites of metastasis. L1 regimens were FFX (n = 621, 61 %), gemcitabine (Gem) (141, 14 %), GN (78, 8 %), and others (n = 172, 17 %). Compared with GN, FFX recipients were younger (61 vs 65 years, p < 0.0001) with better ECOG (≥ 2 in 4 % vs 13 %, p < 0.0001). Median OS was 14.5 months (95 %CI [13.3-15.8]) with FFX, 12.4 [9.4-21.9] with GN, 7.9 [6.5-10.7] with Gem and 9.2 [7.2-13.1] with others (p < 0.0001). Respective median PFS were 7.0 months [95 %CI: 6.5-7.9], 5.4 [4.0-8.3], 4.9 [3.6-6.0] and 5.6 [3.6-7.0] (p < 0.05).
Conclusions:
In this large real-world cohort, FFX was associated with superior response rate, PFS, and OS compared with other L1 regimens, supporting its use as standard first-line therapy for mPDAC.
