Options in First Line Management of Metastatic Pancreatic Cancer and the Determinative Role of ECOG Performance Status
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Date
2021
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Abstract
Objectives: It will contribute to the fact that the first-line treatment options of patients with metastatic pancreatic can- cer (PC) who apply to the oncology clinic are discussed in the light of the literature and guide the clinicians in making the initial treatment decision. Methods: Patients who were diagnosed with PC in a total of 2 centers between 2010 and 2019 and who were found to have distant organ metastases at the time of diagnosis or during follow-up were included. Patients were categorized into 3 groups in terms of metastatic first line treatments: gemcitabine (Gm), gemcitabine-platinum (cisplatin or carbo- platin) (GP) combination and FOLFIRINOX (FX). These three treatment groups were compared in terms of patient with tumor characteristics and progression free survival (PFS) - overall survival (OS). Results: The present study included 355 patients who were admitted to our clinic. The first line therapies received by the patients were analyzed, it was seen that 124 (34.9%) patients received Gm chemotherapy (CT), 43 (12.1%) pa- tients received FX, 138 (38.9%) patients received GP and 18 (5.1%) patients received other regimens. While PFS was 6.1 months in GP areas, it was the shortest with 4.4 months in Gm and the longest with 7.1 months in FX. This difference between the groups was found to be statistically significant (p<0.001). When the data were analyzed in terms of OS; the Gm arm was found to have the shortest OS with 9.6 months. However, GP attracted attention as the treatment that prolonged the OS the most with 15.4 months. This period was calculated as 13.5 months in the FX arm. Again, this dif- ference was found to be statistically significant (p<0.001). Conclusion: The main theme of our study was that ‘Eastern Cooperative Oncology Group’ performance status (ECOG PS) and age were the most important factors in decision making for the management of these patients. As age pro- gresses and PS deteriorates, clinicians move away from the FX regimen. Another important point was that the GP regi- men was preferred instead of GnP, probably due to the difficulty in drug supply in our country, and it was found to be superior to other regimens.