Abstract B35: Outcomes of patients with metastatic pancreatic cancer who progress on first restaging imaging
Authors: Mizrahi Jonathan D. , Rogers Jane E. , Nogueras-Gonzalez Graciela M. , Wolff Robert A. , Varadhachary Gauri R. , Javle Milind M. , Shroff Rachna T. , Ho Linus , Fogelman David R. , Raghav Kanwal P. , Overman Michael J. , Pant Shubham 
Published: March 2020

Background: Objective responses to first-line systemic chemotherapy in patients (pts) with metastatic pancreatic cancer (mPC) are seen in less than one third of cases. While disease stabilization is achievable for a significant percentage, many of these pts will have radiographic evidence of disease progression (PD) on their first restaging imaging. With patients’ short life expectancy in the metastatic setting, limited systemic treatment options, and significant toxicities associated with multidrug chemotherapy, it is crucial for clinicians to be prudent when deciding whom and when to treat. The purpose of our study was to evaluate outcomes of pts who progressed on their first restaging imaging while on first-line therapy.

Methods: We retrospectively analyzed mPC pts treated at MD Anderson since 2011 whose first restaging imaging on first-line therapy demonstrated PD. Data collected included patient demographics, choice of first-line therapy, and whether they received second-line therapy. Primary outcome was overall survival (OS) from date of metastatic diagnosis to death or last follow-up.

Results: A total of 121 pts were included in the analysis. Seventy-two received second-line therapy, and 49 did not pursue second-line therapy. The median ages for pts who did and did not receive second-line therapy were 61 and 67, respectively (p=0.001). More pts had a poor Eastern Cooperative Oncology Group (ECOG) performance status (ECOG 2-3) at the time of initial diagnosis in the non-second-line therapy group (31% vs. 6.9%, p=0.003). Forty-two pts (34.7%) received combination 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) first-line, while 72 pts (59.5%) received gemcitabine + nab-paclitaxel (GnP). Thirty-four pts (80%) who received FOLFIRINOX first-line did proceed with second-line therapy, and 29 pts (40%) who received GnP proceeded with second-line therapy. Median OS for those receiving second-line therapy was 8.28 months compared to 2.73 months for those not receiving second-line therapy (p&lt;0.001).

Conclusions: Although likely biased due to better performance status and younger age, our mPC pts who progressed rapidly on first-line therapy showed an OS benefit if they received second-line therapy. These results suggest that pts maintaining a good performance status after immediate progression on first-line therapy should be offered second-line therapy.

Citation Format: Jonathan D. Mizrahi, Jane E. Rogers, Graciela M. Nogueras-Gonzalez, Robert A. Wolff, Gauri R. Varadhachary, Milind M. Javle, Rachna T. Shroff, Linus Ho, David R. Fogelman, Kanwal P. Raghav, Michael J. Overman, Shubham Pant. Outcomes of patients with metastatic pancreatic cancer who progress on first restaging imaging [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Advances in Science and Clinical Care; 2019 Sept 6-9; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2019;79(24 Suppl):Abstract nr B35.