Survival outcome of different treatment sequences in patients with locally advanced and metastatic pancreatic cancer  

Abstract

Background: Chemotherapy remained the basic treatment for patients with advanced pancreatic cancer. We aimed to evaluate the impact of different treatment sequences on clinical outcomes of advanced pancreatic cancer at our academic institution. Methods: In this single institution retrospective analysis, we assessed characteristics and survival rates from all patients with locally advanced and metastatic pancreatic ductal adenocarcinoma who started a systemic treatment between 01/2015 and 12/2021. Survival analyses were performed by Kaplan-Meier and Cox proportional hazards model. Results: A total number of 285 patients started a systemic treatment in the observation period, and all patients received at least two lines of treatment. The completion rate of third-line chemotherapy was higher in patients who received FOLFIRINOX or mFLORIFINOX in third-line compared with the patients who received FOLFIRINOX regimen in the first or second-line (chi-square, p=0.04). Furthermore, survival rates of three lines (gemcitabine plus nab-paclitaxel or nab-paclitaxel combination therapy to FOLFIRINOX including plus Bevacizumab; nab-paclitaxel combination therapy to gemcitabine combination therapy, or cross, to oxaliplatin or irinotecan combination therapy; and nab-paclitaxel combination therapy to gemcitabine combination therapy, or cross, to FOLFIRINOX including plus Bevacizumab) were significantly different and median overall survival was 14.00, 14.00, and 18.00 months, respectively (p＜0.05). Conclusion: Our study provides real-world evidence for the effectiveness of different treatment sequences and recommends nab-paclitaxel combination therapy to gemcitabine combination therapy, or cross, to FOLFIRINOX+/-Bevacizumab to achieve a best overall survival when considering the entire management in advanced pancreatic cancer.