Results from the prospective German TPK clinical cohort study: Treatment algorithms and survival of 1,174 patients with locally advanced, inoperable or metastatic pancreatic ductal adenocarcinoma
Menée en Allemagne dans un contexte de vie réelle à partir de données portant sur 1 174 patients atteints d'un adénocarcinome canalaire du pancréas de stade localement avancé, inopérable ou métastatique, cette étude de cohorte prospective analyse la survie, en lien avec trois types de chimiothérapies (gemcitabine dispensée en monothérapie, nab-paclitaxel combiné à la gemcitabine, et chimiothérapie de type FOLFORINOX)
Pancreatic cancer is a highly lethal malignancy. Developments in recent years have broadened our therapeutic armamentarium. Novel drugs such as nab-paclitaxel, liposomal irinotecan and chemotherapy regimens such as FOLFIRINOX have been successfully tested in clinical trials. Data on patients outside of clinical trials are scarce but necessary to assess and improve the standard of care. We present data on treatment and survival of 1,174 patients with locally advanced, inoperable or metastatic pancreatic ductal adenocarcinoma. Between February 2014 and June 2017, patients were recruited by 104 sites at start of first-line therapy into the ongoing, prospective clinical cohort study TPK (Tumour Registry Pancreatic Cancer). As first-line therapy, 89% of patients received one of the three treatment regimens: gemcitabine monotherapy (23%), nab-paclitaxel plus gemcitabine (42%) or FOLFIRINOX (24%). The corresponding subgroups differed: Patients receiving gemcitabine monotherapy were older and more comorbid (median age 78 years, 73% ECOG ≥1) than patients receiving nab-paclitaxel plus gemcitabine (median age 71, 64% ECOG ≥1) or patients receiving FOLFIRINOX (median age 60, 52% ECOG ≥1). At least 40% of patients died before receiving second-line treatment. First-line progression-free survival was 4.6 months (95% CI 3.7 – 5.2) for gemcitabine, 5.6 months (95% CI 5.0 – 6.2) for nab-paclitaxel plus gemcitabine and 6.3 months (95% CI 5.5 – 6.9) for FOLFIRINOX. Our data represent the treatment reality in a German community setting. Although there are no stringent inclusion criteria for our cohort study, overall survival is comparable to that reported by randomised clinical trials. This article is protected by copyright. All rights reserved.