Impact of age, bilirubin, and disease burden in unresectable pancreatic cancer patients receiving first-line chemotherapy: A population-based analysis

Abstract

Background: FOLFIRINOX (FFN), nab‐paclitaxel plus gemcitabine (NG), and gemcitabine (gem) are 3 systemic therapies that provide clinically meaningful benefit to patients with unresectable pancreatic cancer (UPC). Clinical trials have previously excluded patients with advanced age, elevated bilirubin, or locally advanced disease. Our aim was to examine whether age, bilirubin, and disease extent affected treatment outcomes. Methods: Patients diagnosed with UPC who initiated palliative chemotherapy from August 2014 to August 2015 at any 1 of 5 cancer centers in British Columbia were identified from the provincial pharmacy. Clinical, pathological, treatment, and outcome characteristics were compared. Results: 150 patients were included: 53% men, 78% ECOG 0/1, and 71% with metastatic disease. Patients who received FFN and NG were younger (p < 0.001), in better performance status (p < 0.001), and exhibited fewer metastases at presentation (p = 0.032) (Table). Bilirubin did not alter treatment selection (p = 0.502). Patients treated with FFN or NG also experienced significantly longer median overall survival (OS) when compared to those treated with gem after adjusting for confounders (11.2 vs 11.6 vs 4.1 months, respectively; FFN: HR 0.391, 95%CI 0.192‐0.796, p = 0.009, and NG: HR 0.239, 95%CI 0.132‐0.430, p < 0.001). Likewise, progression‐free survival (PFS) was longer among patients on FFN or NG in comparison to gem. Neither advanced age nor elevated bilirubin at presentation affected OS (p >0.05). Having metastatic instead of locally advanced disease significantly impacted OS (p <0.001), especially for those on gem (p = 0.020). Conclusions: Receipt of FFN and NG portended a better prognosis than gem alone. In the absence of a randomized comparison of all 3 regimens, our population‐based study revealed that the introduction of modified FFN and NG confers real world effectiveness for UPC patients regardless of age and bilirubin at presentation. (Table Presented).