Background: Positive results of randomized trials led to the introduction of FOLFIRINOX in 2012 and gemcitabine with nab-paclitaxel in 2015 for patients with metastatic pancreatic ductal adenocarcinoma. It is unknown to which extent these new chemotherapeutic regimens have been implemented in clinical practice and what the impact has been on overall survival. Material and methods: Patients diagnosed with metastatic pancreatic ductal adenocarcinoma between 2007–2016 were included from the population-based Netherlands Cancer Registry. Multilevel logistic regression and Cox regression analyses, adjusting for patient, tumor, and hospital characteristics, were used to analyze variation of chemotherapy use. Results: In total, 8726 patients were included. The use of chemotherapy increased from 31% in 2007–2011 to 37% in 2012–2016 (p <.001). Variation in the use of any chemotherapy between centers decreased (adjusted range 2007–2011: 12–67%, 2012–2016: 20–54%) whereas overall survival increased from 5.6 months to 6.4 months (p <.001) for patients treated with chemotherapy. Use of FOLFIRINOX and gemcitabine with nab-paclitaxel varied widely in 2015–2016, but both showed a more favorable overall survival compared to gemcitabine monotherapy (median 8.0 vs. 7.0 vs. 3.8 months, respectively). In the period 2015–2016, FOLFIRINOX was used in 60%, gemcitabine with nab-paclitaxel in 9.7% and gemcitabine monotherapy in 25% of patients receiving chemotherapy. Conclusion: Nationwide variation in the use of chemotherapy decreased after the implementation of FOLFIRINOX and gemcitabine with nab-paclitaxel. Still a considerable proportion of patients receives gemcitabine monotherapy. Overall survival did improve, but not clinically relevant. These results emphasize the need for a structured implementation of new chemotherapeutic regimens.
Bibliographical noteFunding Information:
This work (the Dutch Pancreatic Cancer Project, including the Netherlands Cancer Registry) was supported by the Dutch Cancer Society (KWF Kankerbestrijding) under Grant UVA2013-5842. The authors thank the registration team of the Netherlands Cancer Registry for their dedicated data collection.
JdVS has received non-financial support from BTG, and Servier, and has served as a consultant for Shire and has received institutional research funding from Servier, outside the submitted work. NHM has served as a consultant for BMS, MSD and Lily, outside the submitted work. HvL reports grants from Lilly, Nordic, Celgene, Bayer, Merck Serono, MSD, and Roche, and had an advisory role for Lilly, Celgene, and Bayer, outside the submitted work.
© 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.