Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Patterns of care for metastatic pancreatic cancer in Australian practice. (#297)

Amy Body 1 , Rachel Wong 1 2 3 , Jeremy Shapiro 4 , Azim Jalali 3 5 , Sue-Anne McLachlan 6 7 , Sumi Ananda 3 4 7 8 , Lara Lipton 4 5 , Prasad Cooray 9 , Peter Gibbs 3 5 7 , Belinda Lee 3 7 8 10 , Margaret Lee 1 2 3 5
  1. Medical Oncology, Eastern Health, Melbourne, VIC, Australia
  2. Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
  3. Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
  4. Medical Oncology, Cabrini Hospital, Melbourne, VIC, Australia
  5. Medical Oncology, Western Health, Melbourne, VIC, Australia
  6. Medical Oncology, St Vincent's Hospital, Melbourne, VIC, Australia
  7. Faculty of Medicine and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
  8. Medical Oncology, Peter Macallum Cancer Centre, Melbourne, VIC, Australia
  9. Medical Oncology, Knox Private Hospital, Melbourne, VIC, Australia
  10. Medical Oncology, Northern Health, Melbourne, VIC, Australia

Aim:

To describe current Australian chemotherapy utilisation and clinical outcomes in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) using the multi-site PURPLE (Pancreatic cancer: Understanding Routine Practice and Lifting End Results) registry.

Methods:

PURPLE is a collaborative registry collecting comprehensive longitudinal data on consecutive patients with pancreatic cancer. This study uses data from six Victorian sites for patients diagnosed with mPDAC from October 2012 to May 2019. Data regarding demographics, ECOG performance status (PS), Charlson comorbidity index (CCI), chemotherapy regimens and overall survival (OS) were analysed. There was no formal statistical plan.

Results:

A total of 363 patients with mPDAC were identified; 103 (28%) had progressed after initial localised disease. Median age was 70 years (20-94), 191 (53%) were male. ECOG PS was 0-1 in 285 (79%), median CCI was 3.

First-line chemotherapy was administered in 195 patients (54%). Regimens included gemcitabine-nab-paclitaxel (81%), gemcitabine alone (10%) and FOLFIRINOX (6%).

To date, 59 of 195 (30%) patients who received first-line treatment have proceeded to second-line chemotherapy. The commonest regimens used were: oxaliplatin-fluoropyrimidine (35%), irinotecan-fluoropyrimidine (32%) and gemcitabine-nab-paclitaxel (15%).

The chemotherapy group had a lower median age (69 years versus 73 years, p<0.01), ECOG PS (ECOG 0-1 89% vs 66%, p<0.01) and CCI (3 vs 4, p<0.01) compared with the no chemotherapy group.

Median OS from time of diagnosis of metastases was 5.1 months (all patients). Median OS was 9.2 months in the chemotherapy (9.3 months gemcitabine-nab-paclitaxel pts), and 2.5 months in the no chemotherapy groups (p<0.01).

Conclusions:           

A substantial proportion of routine care patients with mPDAC do not receive active treatment, in part due to poor performance status. Gemcitabine-nab-paclitaxel was the preferred first-line chemotherapy regimen. Median OS was comparable to the MPACT population(1). Uptake of first-line FOLFIRINOX in the metastatic setting remains low despite data to support its use(2).

  1. 1. Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus Gemcitabine. New England Journal of Medicine. 2013;369(18):1691-703.
  2. 2. Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, et al. FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer. New England Journal of Medicine. 2011;364(19):1817-25.