Use and outcomes of chemotherapy for metastatic pancreatic cancer in Australia

Amy Body; Rachel Wong; Jeremy Shapiro; Azim Jalali; Sue-Anne McLachlan; Sumitra Ananda; Lara Lipton; Prasad Cooray; Peter Gibbs; Belinda Lee; Margaret Lee

doi:10.1111/imj.15094

Use and outcomes of chemotherapy for metastatic pancreatic cancer in Australia

Intern Med J. 2022 Jan;52(1):49-56. doi: 10.1111/imj.15094.

Authors

Amy Body¹, Rachel Wong^{1

2

3}, Jeremy Shapiro⁴, Azim Jalali^{3

5}, Sue-Anne McLachlan^{6

7}, Sumitra Ananda^{3

7

8

9}, Lara Lipton^{4

5

9}, Prasad Cooray^{7

10}, Peter Gibbs^{3

5

7}, Belinda Lee^{3

7

9

11}, Margaret Lee^{1

2

3

5}

Affiliations

¹ Department of Medical Oncology, Eastern Health, Melbourne, Victoria, Australia.
² Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia.
³ Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.
⁴ Department of Medical Oncology, Cabrini Hospital, Melbourne, Victoria, Australia.
⁵ Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.
⁶ Department of Medical Oncology, St Vincent's Hospital, Melbourne, Victoria, Australia.
⁷ Faculty of Medicine and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
⁸ Department of Medical Oncology, Epworth Freemasons' Hospital, Melbourne, Victoria, Australia.
⁹ Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
¹⁰ Department of Medical Oncology, Knox Private Hospital, Melbourne, Victoria, Australia.
¹¹ Department of Medical Oncology, Northern Health, Melbourne, Victoria, Australia.

PMID: 33040452
DOI: 10.1111/imj.15094

Abstract

Background: Metastatic pancreatic ductal adenocarcinoma (mPDAC) is highly lethal. Combination chemotherapy regimens improve overall survival (OS). Historically, only one-third of mPDAC patients in Victoria received chemotherapy.

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

Methods: PURPLE collects longitudinal data on consecutive patients with pancreatic cancer seen since January 2016. Data were collated for patients with mPDAC from six Victorian sites, and analysed descriptively.

Results: Three hundred and sixty-three patients with mPDAC were identified. Median age was 70 years (range 20-94 years). First-line chemotherapy was administered in 195 (54%) patients. Prevalent regimens included gemcitabine-nab-paclitaxel (71%), gemcitabine alone (10%) and FOLFIRINOX (6%). Sixty-two of 195 (32%) patients who received first line treatment have proceeded to second-line chemotherapy. Chemotherapy-treated patients were younger (69 versus 73 years; P < 0.01), with better Eastern Cooperative Oncology Group (ECOG) performance status (ECOG 0-1 89 vs 66%; P < 0.01) and lower median Charlson comorbidity index (3 vs 4; P < 0.01) compared with untreated patients. Median OS of the entire cohort from diagnosis of metastases was 5.1 months. Median OS was 9.3 months in the chemotherapy treated patients, and 2.5 months in chemotherapy-untreated patients (P < 0.01).

Conclusions: A substantial proportion of patients with mPDAC still do not receive active treatment, which may in part by explained by age, poor performance status and comorbidity. Gemcitabine-nab-paclitaxel was the preferred first-line chemotherapy regimen. Median OS for treated patients in this cohort was comparable to that of recent published clinical trials.

Keywords: FOLFIRINOX; cancer chemotherapy agent; gemcitabine-nab-paclitaxel; metastatic pancreatic cancer; pancreatic ductal adenocarcinoma.

MeSH terms

Adenocarcinoma* / drug therapy
Adenocarcinoma* / secondary
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Cohort Studies
Humans
Middle Aged
Pancreatic Neoplasms* / drug therapy
Pancreatic Neoplasms* / pathology
Victoria / epidemiology
Young Adult