A Real-World Multicenter Analysis of First (1L) and Second Line (2L) Treatment of Advanced Pancreatic Adenocarcinoma (APC).

e16210 Background: FOLFIRINOX (FFX), gemcitabine/nab-paclitaxel (GN) and gemcitabine (GEM) are 3 available treatments for locally advanced (LAPC) and metastatic (MPC) pancreatic cancer. Without a head-to-head trial, optimal 1L and 2L treatments and their impact on outcomes in the real world remain unclear. Methods: Pooled data from multiple cancer centers across provinces in Canada were analyzed. LAPC and MPC patients (pts) diagnosed from 2014 to 2016 who received at least 1 cycle of systemic therapy were included. Analyses were conducted to characterize 1L and 2L treatment sequences and predictive factors. We also assessed the relationship with overall survival (OS). Results: We identified 302 pts: median age 63 (IQR 56-69), 163 (54%) men, 127 (42%) ECOG ≥ 2, and 221 (73%) MPC. In the 1L setting, 48%, 38% and 14% of pts received FFX, GN and GEM, respectively. FFX was more likely used in younger pts (54% in age < 65 vs. 41% in age ≥ 65, p = 0.04) and those with favorable ECOG (63% in ECOG 0 vs. 13% in ECOG ≥ 2, p < 0.01). Over time, there was increased preference for GN (21% in 2014 vs. 63% in 2016, p < 0.01) and decreased FFX use (66% in 2014 vs. 27% in 2016, p < 0.01). Gender, tumor location and LAPC vs. MPC status did not influence 1L selection (all p > 0.05). Among the 107 (35%) pts who proceeded to 2L, 66%, 25% and 8% received 1L FFX, GN and GEM, respectively. The preferred treatment sequences were FFX to GN (51/107; 48%), FFX to GEM (16/107; 15%), GN to fluoropyrimidine (9/107; 8%) and GN to oxaliplatin-based therapy (7/107; 7%). The receipt of any 2L therapy was associated with higher mOS (14 vs. 7 months, p < 0.01). Similar OS was observed between those who received 2L therapy after 1L FFX vs. after 1L GN (15 vs. 11 months, p = 0.43), and both conferred a survival advantage over 2L therapy after 1L GEM (15 vs. 7 months, p < 0.01 and 11 vs. 7 months, p = 0.02). Adjusting for confounders, 1L FFX and 1L GN followed by 2L therapy were associated with improved OS (HR 0.42, 95% CI 0.24-0.74, p < 0.01 and HR 0.49, 95% CI 0.36-0.68, p < 0.01). Conclusions: In this multicenter study, more than one-third of pts received 2L treatment for APC. Both 1L FFX and 1L GN treatment followed by 2L non-cross-resistant combinations can be considered as they showed similar survival.