Improvement in advanced pancreatic cancer survival with novel chemotherapeutic strategies – experience of a community based hospital

Abstract

Background: New chemotherapeutic strategies for locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC) have been shown to improve survival in randomized clinical trials. Little is known about the use of such chemotherapies and their benefit in community-based hospitals. This retrospective study analyzes the overall survival of these patients under “real life conditions” before and after the introduction of FOLFIRINOX in 2011.

Methods: We retrospectively identified consecutive patients with PDAC who were treated at our hospital from 2011 to June 2014 (2011+ cohort) and 2004 to 2010 (historical cohort). Patients were included if PDAC was diagnosed in a locally advanced or metastatic state and at least 1 cycle of chemotherapy was given. Survival was assessed until April 2016. Patients with FOLFIRINOX were further analyzed regarding drug administration and side effects.

Results: 128 patients met the inclusion criteria. Of the 74 patients in the historical cohort, 62 patients received Gemcitabine. Of the 54 patients diagnosed between 2011 and June 2014, 28 patients received FOLFIRINOX and 22 Gemcitabine as the first-line chemotherapy. Only 34 % of the patients in the historical cohort received a second-line chemotherapy in comparison to 69 % in the 2011+ cohort. Median overall survival (OS) showed a survival of 13.1 months (95 % CI; 11.6 – 14.5) for the 2011+ cohort compared to 9.6 months (95 % CI; 6.1 – 13.1) in the historical group.

Conclusion: This study shows a marked improvement in survival of patients diagnosed with locally advanced or metastatic PDAC in a community-based hospital during the past 4 years. The most likely reasons are the use of new polychemotherapies like FOLFIRINOX and the use of second-line chemotherapy.

Zusammenfassung

Hintergrund: Trotz neuer Kombinationschemotherapien, die in Studien nachweislich das Überleben von Patienten mit Pankreaskarzinom im metastasierten oder lokal fortgeschrittenen Zustand verbessern, ist wenig über deren Einsatz und Benefit in kommunalen Krankenhäusern bekannt. In dieser retrospektiven Analyse untersuchen wir das Gesamtüberleben solcher Patienten in einem kommunalen Krankenhaus vor und nach der Einführung von FOLFIRINOX im Jahre 2011.

Methoden: Patienten mit einem lokal fortgeschrittenen oder metastasierten duktalen Pankreaskarzinom, die mindestens einen Chemotherapiezyklus erhielten, wurden retrospektiv in eine historische Kohorte (2004 – 2010) und eine aktuelle Kohorte 2011+ (2011 – 2014) unterteilt. Gesamtüberleben bis April 2016 und Verträglichkeit von FOLFIRINOX wurden näher untersucht.

Ergebnisse: 128 Patienten erfüllten die Einschlusskriterien. In der historischen Kohorte erhielten 62 der 74 Patienten Gemcitabine. Von den 54 Patienten in der 2011+-Kohorte erhielten 28 Patienten FOLFIRINOX und 22 Patienten Gemcitabine als Erstlinienchemotherapie. Lediglich 34 % der Patienten in der historischen Kohorte erhielten eine Zweitlinienchemotherapie verglichen mit 69 % in der 2011+-Kohorte. Das mediane Gesamtüberleben betrug 13,1 Monate (95 %-KI; 11,6 – 14,5) in der 2011+-Kohorte und 9,6 Monate (95 %-KI; 6,1 – 13,1) in der historischen Kohorte.

Schlussfolgerung: Das Gesamtüberleben von Patienten mit metastasiertem oder lokal fortgeschrittenem Pankreaskarzinom zeigt eine deutliche Verbesserung des Überlebens in den letzten vier Jahren. Wahrscheinliche Gründe sind der Einsatz von Polychemotherapien wie FOLFIRINOX, aber auch der vermehrte Einsatz von Zweitlinienchemotherapien.

Schlüsselwörter

Pankreaskarzinom - Gesamtüberleben - FOLFIRINOX - Kommunales Krankenhaus - Chemotherapie

Key words

pancreatic cancer - survival - FOLFIRINOX - community based hospital - chemotherapy

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