Treatment and survival of locally advanced pancreatic cancer: A prospective multicenter cohort

Background: About 30-40% of patients with a pancreatic malignancy present with locally advanced pancreatic cancer (LAPC). Clinical outcomes are mostly described in highly selected patient cohorts. This study aims to provide an overview of treatment and survival within an unselected, consecutive cohort of patients with LAPC. Methods: Prospective multicenter study including consecutive patients with LAPC according to Dutch Pancreatic Cancer Group (DPCG) criteria between 04/2015-12/2017 from 14 centers. The decision to start treatment was based on the advice of the multidisciplinary team meeting followed by patient consultation of a medical oncologist. Restaging of CT-scans was performed by a nationwide expert panel after two months of systemic treatment. The panel evaluated response according to RECIST criteria, resectability and eligibility for clinical trials. Results: In total, 424 patients were included, of whom 326 (77%) started chemotherapy, 83 (20%) received best supportive care (BSC) and 15 (4%) started other primary treatments. Most patients started FOLFIRINOX (n=255, 78%), 31 patients (10%) were treated with gemcitabine plus nab-paclitaxel and 40 (12%) with gemcitabine monotherapy. 301 patients were restaged of whom 35 (12%) showed partial response, 216 (72%) had stable disease and 50 (17%) demonstrated progression. A total of 33/424 patients (8%) underwent a resection, of which 49% (n=16) were R0. Median overall survival (mOS) in all patients was 11 months (95%CI 10-12). In patients treated with FOLFIRINOX, gemcitabine with nab-paclitaxel, or gemcitabine monotherapy, mOS was 14 (95%CI 12-16), 10 (95%CI 8-12), and 9 months (95%CI 7-11), respectively. Resected patients had a mOS of 22 months (95%CI 14-30). Conclusion: In a national prospective cohort of LAPC, median overall survival was 11 months. 60% of patients received FOLFIRINOX treatment, and 8% underwent resection after neoadjuvant chemotherapy with promising survival. Since treatment allocation bias cannot be excluded future randomized studies are needed.