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Long-term outcome of patients with advanced pancreatic cancer treated with sequential chemotherapies before the era of modern combination therapy protocols

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Introduction

Patients (pts) with locally advanced (LAPC) or metastatic pancreatic ductal adenocarcinoma (mPDAC) have a dismal prognosis. Recently, new combination chemotherapies such as FOLFIRINOX and nab-paclitaxel/gemcitabine have demonstrated superiority over gemcitabine monotherapy. However, a substantial proportion of pts cannot tolerate these intensive front-line protocols. Moreover, the long-term superiority of multiagent protocols over less intensive strategies remains to be shown. To provide a benchmark for future studies, we analyzed the outcome of patients with LAPC or mPDAC treated at the West German Cancer Center before the FOLFIRINOX/nab-paclitaxel + gemcitabine era.

Methods

This retrospective analysis included 201 consecutive pts with LAPC and mPDAC treated between 2007 and 2011. Efficacy parameters were correlated with type of chemotherapy, number of treatment lines and clinicopathological parameters.

Results

Gemcitabine monotherapy was given as first-line therapy in 51.1%, whereas 48.9% received combination chemotherapies such as gemcitabine/oxaliplatin or FOLFOX. Patients received a median of two lines of treatment, with 54.8% receiving second-line and 37.9% receiving third- and further-line therapies. There was no significant difference between gemcitabine monotherapy and combination therapies. Despite moderate activity of first-line treatment, median overall survival for LAPC was 11.3 months and 8.7 months for mPDAC. Multivariate analysis identified age and number of treatment lines as prognostic markers.

Conclusion

The long-term outcome of unselected pts with LAPC and mPDAC treated before the introduction of aggressive multiagent chemotherapy protocols compares favorably with the results of contemporary benchmark trials. This suggests a multifactorial benefit from interdisciplinary care provided over sequential treatment lines at high volume expert centers.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany

    A. Abendroth, R. Noureddine, M. Abramczyk, M. Wiesweg, J. Köhler, M. Markus, M. Schuler & S. Kasper

  2. Department of General, Visceral and Transplant Surgery, West German Cancer Center, University Hospital Essen, Essen, Germany

    A. Paul

  3. Department of Gastroenterology and Hepatology, West German Cancer Center, University Hospital Essen, Essen, Germany

    G. Gerken & A. Dechêne

  4. West German Cancer Center, Institute of Pathology Essen, University Hospital Essen, Essen, Germany

    K. W. Schmid

  5. Department of General Surgery and Traumatology, Elisabeth Hospital Essen, Essen, Germany

    P. Markus

  6. Department of Gastroenterology, Elisabeth Hospital Essen, Essen, Germany

    B. Schumacher

  7. Central Pharmacy, University Hospital Essen, Essen, Germany

    B. Mende

  8. German Cancer Consortium (DKTK), Partner site University Hospital Essen, Essen, Germany

    A. Paul, K. W. Schmid & M. Schuler

  9. Medical Faculty, University Duisburg-Essen, Essen, Germany

    A. Abendroth, A. Paul, G. Gerken, K. W. Schmid, P. Markus, M. Wiesweg, J. Köhler, A. Dechêne, M. Schuler & S. Kasper

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  1. A. Abendroth
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  2. R. Noureddine
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  3. M. Abramczyk
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Corresponding author

Correspondence to S. Kasper.

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Conflict of interest

All authors declare that there are no conflicts of interest in relation to this study.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

A retrospective study does not allow the retrospective obtaining of patient´s informed consent (ICF) from deceased patients. Against this background, the study was approved by the local Ethics Committee of the Medical Faculty of the University Duisburg-Essen (No. 15-6497).

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Suppl. Fig. 1

Kaplan–Meier plot for overall survival (OS) since start of palliative therapy in patients with low (A) or high (B) tumor burden (tumor target sum – TTS <mean or >mean), which received different number of chemotherapy lines. Median OS of patients with TTS<mean and one therapy line: 8.0 months, patients with two therapy lines: 14.4 months and patients with three or more therapy lines 18.5 months (p=0.035 log rank). Median OS of patients with TTS>mean and one therapy line: 4.0 months, patients with two therapy lines: 9.6 months and patients with three or more therapy lines 12.8 months (p=0.005 log rank). (TIF 63 KB)

Supplementary material 2 (TIF 57 KB)

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Abendroth, A., Noureddine, R., Abramczyk, M. et al. Long-term outcome of patients with advanced pancreatic cancer treated with sequential chemotherapies before the era of modern combination therapy protocols. J Cancer Res Clin Oncol 145, 445–455 (2019). https://doi.org/10.1007/s00432-018-2789-z

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  • DOI: https://doi.org/10.1007/s00432-018-2789-z

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