First-Line Pancreatic Cancer Treatment Varies Across Europe, But Aligns With ESMO Guideline

Though treatment of metastatic pancreatic adenocarcinoma (PAC) across Europe generally followed the European Society for Medical Oncology (ESMO) guideline, there weresubstantial geographic variations in treatment patterns used as first-line therapies , according to a retrospective chart review presented at the ESMO World Congress on Gastrointestinal Cancer 2018.¹

Metastatic PAC outcomes remain poor and treatment options are limited. The purpose of this observational study was to determine the treatment patterns and outcomes of patients with metastatic PAC across Europe.

The electronic medical record chart review included 2565 patients represented by 225 physicians located in 9 countries. Patients who had completed first-line treatment between July 2014 and January 2016 were included in the sample population. The median age at metastatic diagnosis was 64 and 57.7% of 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. Most 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.

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%). 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 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.

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

Read more of Cancer Therapy Advisor‘s coverage of the ESMO World Congress on Gastrointestinal Cancer 2018 meeting by visiting the conference page.

Reference

1. 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