Publication

Choice of first line systemic treatment in pancreatic cancer among national experts

Journal Paper/Review - Mar 31, 2020

Units
PubMed
Doi

Citation
Glatzer M, Pless M, Pederiva S, Pestalozzi B, Berger M, Inauen R, Winterhalder R, Montemurro M, Horber D, Putora P. Choice of first line systemic treatment in pancreatic cancer among national experts. Pancreatology 2020; 20:686-690.
Type
Journal Paper/Review (English)
Journal
Pancreatology 2020; 20
Publication Date
Mar 31, 2020
Issn Electronic
1424-3911
Pages
686-690
Brief description/objective

BACKGROUND
Treatment options for patients with metastatic pancreatic cancer depend on various factors, including performance status, tumor burden and patient preferences. Metastatic pancreatic cancer is incurable and many systemic treatment options have been investigated over the past decades. This analysis of patterns of practice was performed to identify decision criteria and their impact on the choice of first-line management of metastatic pancreatic cancer.

MATERIALS AND METHODS
Members of the Swiss Group for Clinical Cancer Research (SAKK) Gastrointestinal Cancer Group were contacted and agreed to participate in this analysis. Decision trees for the first line treatment of metastatic pancreatic cancer from 9 centers in Switzerland were collected and analyzed based on the objective consensus methodology to identify consensus and discrepancies in clinical decision-making.

RESULTS
The final treatment algorithms included 3 decision criteria (comorbidities, performance status and age) and 5 treatment options: FOLFIRINOX, FOLFOX, gemcitabine + nab-paclitaxel, gemcitabine mono and best supportive care.

CONCLUSION
We identified multiple decision criteria relevant to all participating centers. We found consensus for the treatment of young (age below 65) patients with good performance status with FOLFIRINOX. For patients with increasing age and reducing performance status there was a decreasing trend to use gemcitabine + nab-paclitaxel. Gemcitabine monotherapy was typically offered to patients in the presence of comorbidities. For patients with ECOG 3-4, most of the experts recommended BSC.