First- and Second-Line Palliative Systemic Treatment Outcomes in a Real-World Metastatic Pancreatic Cancer Cohort

Esther N. Pijnappel, Willemieke P.M. Dijksterhuis, the Dutch Pancreatic Cancer Group, Lydia G. van der Geest, Judith de Vos-Geelen, Jan Willem B. de Groot, Marjolein Y.V. Homs, Geert Jan Creemers, Nadia Haj Mohammad, Marc G. Besselink, Hanneke W.M. van Laarhoven, Johanna W. Wilmink

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8 Citations (Scopus)


Background: Metastatic pancreatic ductal adenocarcinoma (PDAC) is characterized by a poor survival rate, which can be improved by systemic treatment. Consensus on the most optimal first- and second-line palliative systemic treatment is lacking. The aim of this study was to describe the use of first- and second-line systemic treatment, overall survival (OS), and time to failure (TTF) of first- and second-line treatment in metastatic PDAC in a real-world setting. Patients and Methods: Patients with synchronous metastatic PDAC diagnosed between 2015 and 2018 who received systemic treatment were selected from the nationwide Netherlands Cancer Registry. OS and TTF were evaluated using Kaplan-Meier curves with log-rank test and multivariable Cox proportional hazard analyses. Results: The majority of 1,586 included patients received FOLFIRINOX (65%), followed by gemcitabine (18%), and gemcitabine 1 nabpaclitaxel (13%) in the first line. Median OS for first-line FOLFIRINOX, gemcitabine 1 nab-paclitaxel, and gemcitabine monotherapy was 6.6, 4.7, and 2.9 months, respectively. Compared to FOLFIRINOX, gemcitabine 1 nab-paclitaxel showed significantly inferior OS after adjustment for confounders (hazard ratio [HR], 1.20; 95% CI, 1.02-1.41), and gemcitabine monotherapy was independently associated with a shorter OS and TTF (HR, 1.98; 95% CI, 1.71-2.30 and HR, 2.31; 95% CI, 1.88-2.83, respectively). Of the 121 patients who received second-line systemic treatment, 33% received gemcitabine 1 nab-paclitaxel, followed by gemcitabine (31%) and FOLFIRINOX (10%). Conclusions: Based on population-based data in patients with metastatic PDAC, treatment predominantly consists of FOLFIRINOX in the first line and gemcitabine with or without nab-paclitaxel in the second line. FOLFIRINOX in the first line shows superior OS compared with gemcitabine with or without nab-paclitaxel.

Original languageEnglish
Pages (from-to)443-450
Number of pages8
JournalJournal of the National Comprehensive Cancer Network : JNCCN
Issue number5
Publication statusPublished - May 2022

Bibliographical note

Funding Information:
Disclosures: Dr. de Vos-Geelen has disclosed receiving nonfinancial and institutional research support from Servier, and serving as an advisory board member for Amgen, AstraZeneca, MSD, Pierre Fabre, and Servier. Dr. de Groot has disclosed serving as an advisory board member for BMS and MSD. Dr. Hohammad has disclosed serving as a scientific advisor for Servier, Merck, Eli Lilly, and BMS, and receiving grant/research support from Servier. Dr. van Laarhoven has disclosed serving as a consultant for BMS, Celgene, Lilly, MSD/Merck, Nordic Pharma, and Servier; receiving unrestricted research funding from Bayer, BMS, Celgene, Lilly, Merck Serono, MSD, Nordic, Philips, Roche, and Servier; and serving as a consultant for BMS, Lilly, MSD, Nordic Pharma, and Servier. Dr. Wilmink has disclosed serving as a consultant for Shire, Servier, and Celgene; receiving grant support from Servier, Halozyne, Novartis, Celgene, AstraZeneca, Pfizer, Roche, Amgen, and MSD/Merck; and serving as an advisory board member for Servier, Celgene, MSD/Merck, and Novartis. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Publisher Copyright:
© 2022 Harborside Press. All rights reserved.


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