Patients with pancreatic cancer in WA experience prolonged survival, with many having sufficient performance status to tolerate second and third line therapies, according to a single-centre review.
Writing in the Journal of Gastrointestinal Oncology [link here], the clinician-researchers from the oncology department at St. John of God Hospital, Perth, said the favourable outcomes were likely due to modern therapies and diagnostics.
They conducted a retrospective cohort study including all 251 patients (median age 66, range 25–87; 51% males) with pancreatic ductal adenocarcinoma (PDAC) who presented to the hospital between April 2008 and October 2021.
Of these, 134 patients (53%) had resectable, borderline resectable or locally advanced disease at diagnosis and 117 patients (47%) had metastatic disease.
Findings showed an overall survival in PDAC of 26 months. In the non-metastatic and metastatic groups the median OS was 34 months and 19 months respectively.
Treatment modalities varied between patients, the researchers noted.
Overall, 123 patients were treated with chemotherapy alone, 55 patients had chemoradiotherapy, 34 patients had chemotherapy and surgery and 37 had tri-modality treatment including chemotherapy, surgery and radiotherapy.
Two patients received CyberKnife radiation alone.
The median length of time on chemotherapy was four months for first line treatment and three months for both second line therapy and third line therapy.
Gemcitabine with nab-paclitaxel was the first line chemotherapeutic regimen of choice for the majority of patients with non-metastatic disease (76.9%), followed by FOLFIRINOX (15%). FOLFIRINOX was the most commonly used second line regimen in patients who had progressed and had adequate performance status.
The researchers said their study showed favourable treatment outcomes and that a number of patients might have performance status to tolerate third line treatment, although there needed to be more research to assess optimal regimens.
“The reasons for [the favourable survival figures] likely include access to modern therapies and diagnostic technology. Improvements in healthcare facilities in recent years have also enabled more timely diagnoses and treatment,” they said.
“These are essential factors in the management of PDAC. At least one third of patients with PDAC present with locally advanced disease, usually due to extensive vascular invasion which precludes the possibility of curative surgical resection.
“Following treatment with platinum-based chemotherapy or gemcitabine combination therapy, a minority of cases subsequently achieve sufficient downstaging to allow surgical resection.”
They said the role of chemoradiotherapy in those with locally advanced disease remained controversial, with research yielding mixed results, adding that chemotherapy remained at the forefront of most treatment regimens for PDAC.
The researchers also noted that PDAC was the third most common cause of cancer death in Australia preceding prostate and breast cancer, however, there were significantly less interventional clinical trials that were active or recruiting.
They said further studies should assess survival and quality of life outcomes prior to implementation of third line chemotherapy into standard of care treatment.