clinical study insights

Impact of Newly Approved Treatment Regimens on Practice Patterns in Pancreatic Cancer

by Thomas A. Abrams, MD


Clinical Study Title:
Patterns of Chemotherapy Use in a U.S.-Based Cohort of Patients With Metastatic Pancreatic Cancer

Clinical Study Abstract:

  • Purpose: Few population studies have examined patterns of systemic therapy administration in metastatic pancreatic cancer (MPC) or the predictors associated with specific treatment choices.
  • Patients and Methods: We assessed 4011 consecutive MPC patients who received chemotherapy between January 2005 and December 2015 at academic, private, and community-based oncology practices subscribing to a US-wide chemotherapy order entry system capturing disease, patient, provider, and treatment data. Multivariate analyses of these prospectively recorded characteristics identified significant predictors of specific therapeutic choices.
  • Results: Overall, 100 different regimens were used in first-line treatment of MPC. First-line gemcitabine monotherapy usage fell steadily from 72% in 2006 to 16% in 2015. This steep decline mirrored increases in first-line usage of both 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) and gemcitabine + nab-paclitaxel. Younger male patients were more likely to receive FOLFIRINOX as first-line treatment, whereas patients treated at community practices and by oncologists with lower MPC patient volume were more likely to receive gemcitabine plus nab-paclitaxel (all P ≤ 0.05). Among all patients receiving first-line chemotherapy for MPC, 49% went on to receive second-line therapy and 19% received third-line therapy. Administration of second- and third-line therapies increased steadily over the time course of follow-up. Younger patients and those treated by oncologists with higher MPC patient volume were more likely to receive second- and third-line therapies.
  • Conclusion: This population-based study provides insight into treatment patterns of MPC in the United States. Usage patterns varied greatly according to patient and provider characteristics.

Abrams TA, Meyer G, Meyerhardt JA, Wolpin BM, Schrag D, Fuchs CS. Patterns of chemotherapy use in a U.S.-based cohort of patients with metastatic pancreatic cancer. Oncologist. 2017 May 5. pii: theoncologist.2016-0447. doi: 10.1634/theoncologist.2016-0447. [Epub ahead of print]

Expert Commentary

Thomas A. Abrams, MD

Assistant Professor of Medicine
Harvard Medical School
Senior Physician
Dana-Farber Cancer Institute
Boston, MA

Options for treatment of MPC have expanded greatly in recent years. This article nicely illustrates how these modern regimens have impacted the treatment landscape. Abrams et al conducted a population-based study of MPC treatment patterns in the United States from 2005 through 2015. Over that time, first-line gemcitabine monotherapy usage plunged from 72% of patients in 2006 to 16% in 2015. Patients treated in recent years were much more likely to receive multidrug regimens such as FOLFIRINOX and gemcitabine + nab-paclitaxel, 2 regimens both shown to improve overall survival (OS) and progression-free survival (PFS) over gemcitabine monotherapy in randomized, phase 3 clinical trials. Additionally, patients who received multidrug regimens were much more likely to receive second- and third-line chemotherapy.

“Patients treated in recent years were much more likely to receive multidrug regimens such as FOLFIRINOX and gemcitabine + nab-paclitaxel, 2 regimens both shown to improve OS and PFS over gemcitabine monotherapy.”

Thomas A. Abrams, MD


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