ESMO WCGI: Study highlights first-line treatment variations for pancreatic cancer

A retrospective chart review presented at the ESMO World Congress on Gastrointestinal Cancer 2018 (ESMO-GI) (20–23 June, Barcelona, Spain) has demonstrated that although the treatment of metastatic pancreatic adenocarcinoma (PAC) across Europe generally follows the European Society for Medical Oncology (ESMO) guideline, there are substantial geographic variations in treatment patterns used as first-line therapies.

The electronic medical record chart review involved 2565 patients represented by 225 physicians located in 9 countries; with the aim to determine the treatment patterns and outcomes of patients with metastatic PAC across Europe.

It included patients who had completed first-line treatment between July 2014 and January 2016. The median age at metastatic diagnosis was 64 and 57.7% of the patients were male. The median laboratory parameters at the start of first-line treatment was 457 U x mL^-1 for CA19-9, 32.0 g x L^-1 for albumin and 1.30 mg x dL^-1 for bilirubin. The majority of patients had a performance status of 1, followed by 2 and 0.

The most commonly used first-line regimen was modified fluorouracil (5-FU), leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) at 35.6%, followed by gemcitabine plus nab-paclitaxel at 25.7%, and single-agent gemcitabine at 20.5%. Other gemcitabine-based combinations with other agents such as oxaliplatin, erlotinib, or capecitabine occurred were used in less than 10% of patients.

The researchers found that physicians in France and the United Kingdom used FOLFIRINOX more frequently than in Germany, Italy, and Spain (40.1% – 47.4% vs 27.2% – 33.5%).

Additionally, gemcitabine plus nab-paclitaxel was most frequently administered in Italy, Spain, and Germany (31.0% – 36.4%) compared with France and the United Kingdom (10.9% – 17.9%). Single-agent gemcitabine was used most frequently in France and the United Kingdom (26.8% – 23.4%) compared with Germany, Italy, and Spain (15.9% – 19.8%).

The research also highlighted that the most frequently used second-line regimens were gemcitabine- (53.3%) or F-FU–based (45.0%), including 5-FU plus oxaliplatin, 5-FU plus irinotecan, single-agent F-FU, or gemcitabine monotherapy.

Overall, the authors have concluded that differences in the treatments used across Europe followed ESMO recommendations and the country-specific differences were likely to be attributable to local reimbursement status.

Source: Taieb J, Carrato A, àMellbring, et al. Geographic [LB2] variation in systemic treatment of metastatic pancreatic adenocarcinoma (mPAC) patients in real world across Europe. Ann. Oncol. 2018;29 (suppl 5;abstr O-002):v100-10. doi:10.1093/annonc/mdy149 (2018)