Abrams TA, et al. – Authors of this work aspired to determine the patterns of chemotherapy use in a U.S.–based cohort of patients with metastatic pancreatic cancer (MPC). An insight into treatment patterns of MPC was provided in the U.S. by this study. Based on patient and provider characteristics, usage patterns varied greatly.

Methods

• 4,011 consecutive MPC patients who received chemotherapy between January 2005 and December 2015 at academic, private, and community-based oncology practices subscribing to a U.S.-wide chemotherapy order entry system capturing disease, patient, provider, and treatment data, were evaluated.
• Significant predictors of specific therapeutic choices were determined by multivariate analyses of these prospectively recorded characteristics.

Results

• In first-line treatment of MPC, 100 different regimens were used.
• A fall of first-line gemcitabine monotherapy usage from 72% in 2006 to 16% in 2015, was observed.
• Moreover, 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.
• On the other hand, patients treated at community practices and by oncologists with lower MPC patient volume were more likely to receive gemcitabine plus nab-paclitaxel (all p≤.05).
• 49% went on to receive second-line therapy and 19% received third-line therapy, among all patients receiving first-line chemotherapy for MPC.
• Over the time course of follow-up, administration of second- and third-line therapies increased steadily.
• As per the observations, younger patients and those treated by oncologists with higher MPC patient volume were more likely to receive second- and third-line therapies.