Search

Background: Over the past two decades, our group has conducted five multicenter trials focusing on first-line systemic therapy for patients with advanced pancreatic cancer. The current pooled analysis was designed to evaluate prognosis over time and the impact of clinical characteristics on survival., Patients and Methods: Individual patient data were derived from five prospective, controlled, multicenter trials conducted by the 'Arbeitsgemeinschaft Internistische Onkologie' (AIO): 'Gem/Cis', 'Ro96', 'RC57', 'ACCEPT' and 'RASH', which recruited patients between December 1997 and January 2017., Results: Overall, 912 patients were included. The median overall survival (OS) for all assessable patients was 7.1 months. OS significantly improved over time, with a median OS of 8.6 months for patients treated from 2012 to 2017 compared with 7.0 months from 1997 to 2006 [hazard ratio (HR) 1.06; P < 0.004]. Eastern Cooperative Oncology Group performance status (HR 1.48; P < 0.001), use of second-line treatment (HR 1.51; P < 0.001), and Union for International Cancer Control (UICC) stage (III versus IV) (HR 1.34, P = 0.002) had a significant impact on OS. By contrast, no influence of age and gender on OS was detectable. Comparing combination therapy with single-agent chemotherapy did not demonstrate a survival benefit, nor did regimens containing epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) such as afatinib or erlotinib, compared with chemotherapy-only arms. Patients with early-onset pancreatic cancer (age at study entry of ≤50 years, n = 102) had a similar OS compared with those >50 years (7.1 versus 7.0 months; HR 1.13; P = 0.273). The use of a platinum-containing regimen was not associated with better outcomes in patients with early-onset pancreatic cancer., Conclusions: Within this selected group of patients treated within prospective clinical trials, survival has shown improvement over two decades. This effect is likely attributable to the availability of more effective combination therapies and treatment lines, rather than to any specific regimen, such as those containing EGFR-TKIs. In addition, concerning age and sex subgroups, the dataset did not provide evidence for distinct clinical behavior., Competing Interests: Disclosure LW has received honoraria for scientific presentations and reports an advisory board role in Roche and Servier; and travel accommodation expenses from Amgen. VH has received honoraria for talks and advisory board role from Merck, Amgen, Roche, Sanofi, Servier, Pfizer, Pierre-Fabre, AstraZeneca, BMS, MSD, Novartis, Terumo, OncoSil, NORDIC, Seagen, and GSK; and research funding from Merck, Amgen, Roche, Sanofi, Boehringer-Ingelheim, SIRTEX, and Servier. ARS has received honoraria from Amgen, Roche, Merck Serono, BMS, MSD, MCI Group, and AstraZeneca; for advisory and consultancy from Amgen, Roche, Merck Serono, BMS, MSD, AstraZeneca, and Pierre Fabre; research grant/funding from Roche, Celgene, Ipsen, Amgen, Alexion Pharmaceuticals, AstraZeneca, Lilly, Servier, AIO-Studien-gGmbH, Rafael Pharmaceutics, Erytech Pharma, and BioNTech; and travel expenses Roche, Amgen, and Pierre Fabre. JTS receives honoraria as a consultant or for continuing medical education presentations from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Immunocore, MSD Sharp Dohme, Novartis, Roche/Genentech, and Servier; his institution receives research funding from Abalos Therapeutics, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eisbach Bio, and Roche/Genentech; and he holds ownership and serves on the board of directors of Pharma15, all outside the submitted work. MS has received honoraria from Lilly, Roche, and Servier. KD has received travel support from Servier, GSK, and BMS; as well as honoraria from AstraZeneca. DZ has received honoraria and travel support from AstraZeneca. CBW has received honoraria from Amgen, Bayer, BMS, Chugai, Celgene, Falk, GSK, MSD, Merck, Janssen, Ipsen, Roche, Servier, Sirtex, and Taiho; has served on advisory boards for Bayer, BMS, Celgene, Janssen, MSD, Servier, Shire/Baxalta, Rafael Pharmaceuticals, RedHill, and Roche; has received travel support from Bayer, Celgene, Janssen, RedHill, Roche, Servier, and Taiho; research grants (institutional) from Roche; serves as an officer for European Society of Medical Oncology (ESMO), Deutsche Krebshilfe (DKH), and Arbeitsgemeinschaft Internistische Onkologie (AIO); and is a member of the EU Commission expert group: Mission Board for cancer. SB had a consulting and advisory role for Celgene, Servier, Incyte, Fresenius, Janssen-Cilag, AstraZeneca, MSD, and BMS; and has received honoraria for scientific presentations from Roche, Celgene, Servier, and MSD. MH has received travel support from Servier and honoraria for scientific presentations from the Falk Foundation. All other authors have declared no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)